Provider Engagement Specialist III-North Eastern

Job Summary

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.

• 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
• Market lead for 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 and ensuring timely and appropriate loading
• Coordinate the account strategy and provide account support with the goal of driving the overall satisfaction and engagement of Provider network
• Negotiate and re-negotiate hospital, ancillary, physician and behavioral health contracts, terms, reimbursement rates, etc., in a manner that complies with corporate policies
• Analyze financial data to establish network strategic initiatives, partnerships, and to establish rates in collaboration with leadership and Finance
• Knowledgeable 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 JOC's (Joint Operating Committees) with key health partners and be able to develop and present data on Provider performance
• Enhance effectiveness of Providers  population health through a variety of 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 the Provider to develop and enhance the practice s engagement strategies for individual members
• As requested, become a Subject Matter Expert on specific provider types
• Provide on-site practice transformation support and education to Providers identified as partners in the Care Source PCMH program. Care Source supports the NCQA Patient Centered Medical Home model.
• Resolving complex or non-routine Provider questions, issues, and problems within 30 days or less and communicating as needed
• Works with leadership and stakeholders to evaluate policy and process changes for potential provider impacts, monitors implementation of key initiatives, and provides leadership on initiatives affecting providers
• Ensures Care Source 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

• 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, to include 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 level with Microsoft Outlook Word, and Excel
• Knowledge of Provider Network Management Processes & Services
• Ability to manage and prioritize multiple tasks, promote teamwork and fact-based decision making
• Strong negotiation skills
• Effective oral and written communication skills
• Critical listening and thinking skills
• Training/teaching skills
• Time management skills

• Employment in this position 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, if you have started employment in this position, your employment in this position will be terminated
• To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza…