BH Provider Engagement Specialist III

CareSource • Boston, MA

5d • $72,200 - $115,500 • 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. This role involves executing quality, engagement, and contracting strategies, developing provisions based on cost and quality analysis, and monitoring key metrics for assigned markets. The specialist will coordinate account strategy, provide account support to drive provider satisfaction and engagement, and negotiate contracts, terms, and reimbursement rates. They will analyze financial data to establish network strategic initiatives and rates, and ensure compliance with federal and state laws pertaining to provider contracting. The role also includes driving quality outcomes through Value Based Reimbursement agreements, leading Joint Operating Committees (JOCs), and enhancing provider effectiveness in population health through quality improvement techniques. Collaboration with the Population Health Analytics team for data exchange and strategic plan development is key. The specialist will also assist in developing practice engagement strategies for members, act as a Subject Matter Expert on specific provider types, and provide on-site practice transformation support for the CareSource PCMH program. Resolving complex provider issues within 30 days, evaluating policy changes, ensuring regulatory compliance, and mentoring new hires are also core responsibilities. This job description is not all inclusive and CareSource reserves the right to amend it at any time.

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, to include 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; exceptions may be considered, due to business need.
• 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 for identified Market performance and engagement strategic initiatives.
• 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.
• 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.
• 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.
• 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.

Benefits

• In addition to base compensation, you may qualify for a bonus tied to company and individual performance.
• We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

What This Job Offers

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