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 and quality analysis; monitor key metrics for assigned Market performance and engagement strategic initiatives under direct supervision.
• Lead performance and engagement activities to support overall network performance, new products, and product expansion.
• Responsible for provider recruitment, contracting, initiating loading and credentialing processes, and ensuring timely and appropriate loading.
• Coordinate account strategy and provide account support to drive overall 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.
• Ensure 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 in coordinating 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 (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.
• Employment is conditional pending successful clearance of a driver’s license record check. If the driver’s license record 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.
• Six Sigma Certification or Project Management certification 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.

Working Conditions

• Mobile Worker: Regular travel to different work locations is essential.
• Exposure to weather conditions typical of the location; may be required to stand and/or sit 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 for work-related travel.
• Required to use 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

Benefits

CareSource is highly invested in every employee’s total well-being and offers a substantial and comprehensive total rewards package.