GENERAL DESCRIPTION:
Responsible for optimizing the processes within the unit, leading efforts to streamline internal workflows, reduce inefficiencies, and ensure that our providers operations administration are aligned with regulatory requirements and organizational goals. Analyzes market trends and regulations to implement provide recommendations and implement effective solutions within the administration of providers.
ESSENTIAL FUNCTIONS:
• Researches and benchmarks competitor strategies to identify operational best practices and recommend improvements for efficiency and performance.
• Designs provider compensation models that support financial sustainability, drive quality outcomes, and enhance member satisfaction.
• Analyzes Medicare Advantage market trends and Centers for Medicare and Medicaid Services (CMS) data to identify operational impacts and support strategic planning.
• Measures provider performance using clinical, financial, and satisfaction metrics to inform strategic decisions and optimize compensation structures.
• Streamlines departmental workflows to eliminate inefficiencies, reduce administrative burden, and improve service delivery across teams.
• Leads cost containment initiatives by identifying operational cost drivers and implementing targeted process improvements.
• Enhances provider-facing systems and tools to ensure they are intuitive, effective, and aligned with provider workflows and needs.
• Promotes adoption of the Relisc Reporting platform through training, usability improvements, and integration into daily provider operations.
• Evaluates user feedback and performance data to implement enhancements to the Relisc platform that improve functionality and engagement.
• Develops and maintains Power BI dashboards to visualize key performance indicators (KPIs), operational metrics, and strategic insights.
• Collaborates with cross-functional teams to align operational strategies with organizati
📌 Providers Efficiency Manager (San Juan)
🏢 MCS Healthcare Holdings, LLC (MCS)
📍 San Juan
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