BH Provider Engagement Specialist III

About the Role

The Behavioral Health Provider Engagement Specialist III is responsible for provider contracting services, provider assistance, and acts as the engagement lead for high-value, strategic behavioral health partners in the Massachusetts market.

Responsibilities

• Execute the quality, engagement, and contracting strategy; develop provisions based on cost, quality analysis, and monitor key metrics.
• Lead market performance and engagement strategic initiatives under direct supervision.
• Support overall network performance, new products, and product expansion through performance and engagement activities.
• Oversee provider recruitment, contracting, and initiate loading and credentialing processes to ensure timely and appropriate completion.
• Coordinate account strategy and provide support to drive satisfaction and engagement of the provider network.
• Negotiate and re-negotiate hospital, ancillary, physician, and behavioral health contracts, terms, and reimbursement rates in compliance with corporate policies.
• Analyze financial data to establish network strategic initiatives, partnerships, and rates in collaboration with leadership and Finance.
• Maintain knowledge of federal and state laws and regulations pertaining to provider contracting.
• Drive quality outcomes through execution and support of Value-Based Reimbursement agreements with providers.
• Assume a leadership role in Joint Operating Committees (JOCs) with key health partners; develop and present data on provider performance.
• Enhance effectiveness of providers’ population health through member health outcome and quality improvement techniques.
• Collaborate with the Population Health Analytics team to coordinate the exchange of clinical information and member/population-level data.
• Assist in the development and implementation of strategic plans in collaboration with leadership and the population health analytics team.
• Collaborate with providers to develop and enhance practice engagement strategies for individual members.
• Serve as a Subject Matter Expert on specific provider types as requested.
• Provide on-site practice transformation support and education to providers identified as partners in the CareSource PCMH program, supporting the NCQA Patient-Centered Medical Home model.
• Resolve complex or non-routine provider questions, issues, and problems within 30 days or less.
• Work with leadership and stakeholders to evaluate policy and process changes for potential provider impacts, monitor implementation of key initiatives, and provide leadership on initiatives affecting providers.
• Ensure CareSource complies with regulatory requirements, addresses compliance concerns, achieves accreditation standards, and participates in market audits.
• Mentor and/or train new hires.
• Perform any other job duties as requested.

Requirements

• Bachelor’s degree in a healthcare-related field or equivalent years of relevant work experience is required.
• Master’s degree is preferred.
• Minimum of five (5) years of healthcare experience, including three (3) years of direct work experience in provider relations and/or provider contracting.
• Managed care experience is required.
• NCQA PCMH experience is preferred.

Skills

• Intermediate proficiency with Microsoft Outlook, Word, and Excel.
• Knowledge of Provider Network Management Processes & Services.
• Ability to manage and prioritize multiple tasks, promote teamwork, and make fact-based decisions.
• Strong negotiation skills.
• Effective oral and written communication skills.
• Critical listening and thinking skills.
• Training/teaching skills.
• Time management skills.
• Six Sigma Certification or Project Management certification preferred.
• Behavioral health credentials preferred.

Licensure and Certification

• Employment is conditional pending successful clearance of a driver’s license record check.
• Annual proof of Influenza vaccination is required for designated positions during Influenza season (October 1 – March 31).

Working Conditions

• This is a mobile position requiring regular travel to different work locations; exposure to typical weather conditions and standing/sitting for long periods.
• Must reside in the same territory assigned to work in; exceptions may be considered due to business need.
• May be required to travel greater than 50% of the time; a valid driver’s license, car, and insurance are necessary.
• Use of general office equipment such as telephone, photocopier, fax machine, and personal computer.
• Flexible hours, including possible evenings and/or weekends as needed to represent CareSource.

Pay

$72,200.00 - $115,500.00. Salary is determined by a combination of education, training, experience, scope and complexity of the role, discretion required, and external/internal data. Bonus eligibility is tied to company and individual performance.

Benefits

CareSource offers a substantial and comprehensive total rewards package focused on every employee’s total well-being.