Provider Program Quality & Integration Consultant I/II

Excited to grow your career?We value our talented employees, and strive to help employees grow professionally. If you think the open position you see is right for you, we encourage you to apply Job Description: Summary: The Provider Program Quality & Integration Consultant facilitates the development and effective implementation of quality and incentive programs and contracts. This work directly impacts the Excellus clinical provider network and member populations. As an individual contributor, this role is a combination of researcher, consultant, strategist, and analyst that facilitates the successful execution of business strategy. The incumbent builds vision, consensus, and commitment among stakeholders such as physicians, nurses, health system executives, quality leadership, vendor partner leadership, and community leaders using industry measurement methodologies, clinical best practice, and empirically sourced change management practices. This position serves as the subject matter expert in all aspects of quality improvement, measurement, and network implementation to increase efficiency and productivity while reducing waste and costs. Essential Accountabilities: Level I u2022 Develops, negotiates, administers, and maintains contracted quality improvement programs: u2022 Health plan quality goal and national measurement SME, including CMS, HEDIS, QARR, STAR, CAHPS measures. u2022 Data mining and analysis ability to formulate solutions and narrate program value stories. u2022 Process improvement, healthcare quality trend and project leadership SME. u2022 Locates and submits clinical evidence/best practice associated with program development and implementation to inform network and vendor proposals. u2022 Evaluates and reports quality program statuses and outcomes to determine impact of interventions using direct and proxy measurement and validation. u2022 Develops process standardization and workflow recommendations for quality programs and contracts in development. u2022 Supports and executes network and vendor programs which improve the quality, safety, and accessibility of care while lowering costs through implementation of strategic initiatives. u2022 Ensures program alignment with organizational goals and existing provider network relationships. u2022 Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companiesu2019 mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs. u2022 Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. u2022 Regular and reliable attendance is expected and required. u2022 Performs other functions as assigned by management. Level II (in addition to Level I Accountabilities) u2022 Manages network and vendor engagements including, vendor selection, contract negotiation, contract process oversight, and vendor implementation with other key business areas as appropriate. u2022 Provides oversight and direction in managing day to day operations of complex projects and programs, including associated reporting while remaining compliant with mandates. u2022 Independently develops novel program proposals focused on quality improvement and cost savings utilizing network relationships and competitive market analysis. u2022 Provides recommendations, builds collaboration, and focuses team efforts through regular presentation. Takes the initiative to interface with matrixed groups related to program development and implementation. u2022 Takes a systematic delivery view of the portfolio: identifying, developing, and managing cross-dependent projects, to increase efficiency and effectiveness while addressing barriers and risks. u2022 Is a primary contact for matrixed implementation of initiatives, including oversight of strategic programs that involve external organizations. u2022 Educates, mentors, and coaches members of the program team throughout the course of development and implementation to ensure the goals of the program are realized in alignment with its strategic mission and vision. u2022 Works closely with those accountable for driving clinical changes from both the delivery system and the Health plan to obtain feedback regarding the viability of programs and provider needs. u2022 Participates in critical activities such as strategic planning and thought leadership at a departmental, cross functional and organization level. Minimum Qualifications: NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities. All Levels u2022 Minimum of 5 years of related work experience. u2022 Bacheloru2019s degree in Nursing, Business or Healthcare Administration, Analytics, Project Management, or related fields preferred. u2022 Applied knowledge of quality improvement, accreditation, or regulatory compliance. u2022 Demonstrated quality principles, proficiency in problem solving and quality tools/techniques. u2022 Strong communication skills required, including ability to effectively communicate verbally and in writing, internally and externally, and across the organization and all levels of management. u2022 Strong facilitation skills. u2022 Strong understanding and application of vendor management skills. u2022 Skilled speaker and presenter experienced in defining, socializing, and sustaining change across diverse groups. u2022 Very strong analytical and business process development skills. u2022 Demonstrated experience in project leadership or principles such as Lean Six Sigma, CPC, process mapping, tests of change, or PDSA cycles. u2022 Demonstrated experience communicating with senior management in various formats, informal discussions, written reports, scheduled meetings, and executive level presentations. u2022 Knowledge and experience working in the healthcare, health insurance or similar industry. Level II (in addition to Level I Qualifications) u2022 Three years of additional related experience. u2022 PMI Certification/ PMP Certification or other project management certification preferred. u2022 Demonstrated knowledge of network and vendor experience in relation to quality. u2022 Prior program implementation experience preferred. u2022 Prior network and product experience. Physical Requirements: u2022 Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time. u2022 Ability to travel across the Health Plan service region for meetings and/or trainings as needed. In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): Level I: Grade E3: Minimum $60,410 - Maximum $106,929 Level II: Grade E5: Minimum $71,880 - Maximum $129,384 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the positionu2019s minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. With about 4,000 employees, 31 counties, and serving the needs of over 1.5 million members, you can imagine the gamut of skills it takes to keep our organization growing and our members flourishing. As an internal job seeker, this means growth and development in many directions, divisions, and roles.Take a look at information regarding our hiring process here. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Created: 2026-02-20