Provider Engagement Specialist III- Mississippi- Central West and Coastal Region

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance.

About the Role

The Provider Engagement Specialist III is responsible for provider contracting services, provider assistance, and acts as the engagement lead for high value, strategic health partners.

Responsibilities

• Execute the quality, engagement, and contracting strategy; develop provisions based on cost, quality/analysis, and monitor key metrics for the assigned Market.
• Lead for identified Market performance and engagement strategic initiatives under the direct supervision of their manager.
• Lead performance and engagement activities to support overall network performance, new products, and product expansion.
• Responsible for provider recruitment, contracting, and initiating the loading and credentialing processes; ensure timely and appropriate loading.
• Coordinate the account strategy and provide account support with the goal of driving overall satisfaction and engagement of the Provider network.
• Negotiate and re-negotiate hospital, ancillary, physician, and behavioral health contracts, terms, reimbursement rates, etc., in compliance with corporate policies.
• Analyze financial data to establish network strategic initiatives, partnerships, and rates in collaboration with leadership and Finance.
• Apply 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 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 Population Health Analytics team in coordinating the exchange of clinical information and member/population level data.
• Assist in development and implementation of strategic plans in collaboration with leadership and 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 (NCQA Patient Centered Medical Home model).
• Resolve complex or non-routine Provider questions, issues, and problems within 30 days or less; communicate as needed.
• 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.
• Intermediate proficiency with Microsoft Outlook, Word, and Excel.
• Knowledge of Provider Network Management Processes & Services.
• Strong negotiation, oral, and written communication skills.
• Critical listening and thinking skills; training/teaching skills.
• Ability to manage and prioritize multiple tasks, promote teamwork, and use fact-based decision making.
• Time management skills.
• Six Sigma Certification or Project Management certification preferred.

Licensure and Certification

• Employment is conditional pending successful clearance of a driver’s license record check. If results are unacceptable, the offer will be withdrawn or employment terminated.
• Annual Influenza vaccination is required (October 1 – March 31) as a condition of continued employment. Employees hired during this period have thirty (30) days to comply.
• CareSource provides reasonable accommodations for qualified individuals with disabilities, medical conditions, or sincerely held religious beliefs.

Working Conditions

• Mobile Worker: Regular travel to different work locations is essential. Exposure to typical weather conditions of the location; may require standing or sitting for long periods.
• Must reside in the same territory assigned to work; 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

$64,980.00 - $103,950.00

Skills

• Fostering a Collaborative Workplace Culture
• Cultivate Partnerships
• Develop Self and Others
• Drive Execution
• Influence Others
• Pursue Personal Excellence
• Understand the Business