BH Provider Engagement Specialist III

CareSource Management Services • Boston, MA

3d • Remote

About The Position

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 BH health partners. Essential Functions: Execute the quality, engagement, and contracting strategy, develop provisions based on cost, quality/analysis and monitor key metrics for the assigned Massachusetts 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 CareSource PCMH program. CareSource 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 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
• Minimum of five (5) years of healthcare experience
• Three (3) years of direct work experience in provider relations and/or provider contracting
• Managed care experience is required
• 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
• Influenza vaccination is a requirement of this position
• Reside in the same territory they are assigned to work in
• May be required to travel greater than 50% of time to perform work duties
• A valid driver’s license, car, and insurance are necessary for work related travel
• Required to use general office equipment such as a telephone, photocopier, fax machine, and personal computer

Nice To Haves

• Master’s Degree is preferred
• NCQA PCMH experience is preferred
• Six Sigma Certification or Project Management certification preferred
• Behavioral health credentials preferred

Responsibilities

• Execute the quality, engagement, and contracting strategy
• Develop provisions based on cost, quality/analysis and monitor key metrics for the assigned Massachusetts Market Lead
• Support identified Market performance and engagement strategic initiatives
• Support overall network performance, new products, and product expansion
• Responsible for provider recruitment, contracting and initiating the loading and credentialing processes
• Coordinate the account strategy and provide account support to drive provider satisfaction and engagement
• Negotiate and re-negotiate hospital, ancillary, physician and behavioral health contracts, terms, and reimbursement rates
• Analyze financial data to establish network strategic initiatives, partnerships, and rates
• Drive quality outcomes through execution and support of Value Based Reimbursement agreements
• Assume leadership role in JOC’s (Joint Operating Committees) with key health partners
• Develop and present data on Provider performance
• Enhance effectiveness of Providers’ population health through quality improvement techniques
• Collaborate with Population Health Analytics team in coordinating the exchange of clinical information and data
• Assist in development and implementation of strategic plans
• Collaborate with the Provider to develop and enhance practice’s engagement strategies for individual members
• Become a Subject Matter Expert on specific provider types
• Provide on-site practice transformation support and education to Providers in the CareSource PCMH program
• Resolve complex or non-routine Provider questions, issues, and problems within 30 days or less
• Evaluate policy and process changes for potential provider impacts
• Monitor implementation of key initiatives
• Ensure compliance with regulatory requirements, accreditation standards, and participate in market audits
• Mentor and/or train new hires

Benefits

• Compensation Range: $72,200.00 - $115,500.00
• In addition to base compensation, you may qualify for a bonus tied to company and individual performance.
• Substantial and comprehensive total rewards package

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level