Health Partner Engagement Specialist II

CareSource • Ohio WFH, OH

20h • $72,200 - $115,500 • Remote

About The Position

CareSource Military & Veterans (CSMV) is dedicated to improving health care access and delivery for veterans and military families in service to our nation. 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. This role executes the quality, engagement, and contracting strategy, develops provisions based on cost, quality/analysis and monitors key metrics for the assigned Market Lead for identified Market performance and engagement strategic initiatives. It also serves as the market lead for performance and engagement activities to support overall network performance, new products, and product expansion. The position is responsible for provider recruitment, contracting and initiating the loading and credentialing processes, and ensuring timely and appropriate loading. It coordinates the account strategy and provides account support with the goal of driving overall satisfaction and engagement of the Provider network. The role involves negotiating and re-negotiating hospital, ancillary, physician, and behavioral health contracts, terms, and reimbursement rates in compliance with corporate policies. It analyzes financial data to establish network strategic initiatives, partnerships, and rates in collaboration with leadership and Finance. The specialist is knowledgeable of federal and state laws and regulations pertaining to provider contracting, drives quality outcomes through execution and support of Value Based Reimbursement agreements with providers, and assumes a leadership role in JOC’s (Joint Operating Committees) with key health partners, presenting data on Provider performance. The role enhances the effectiveness of Providers’ population health through member health outcome and quality improvement techniques, collaborates with the Population Health Analytics team for clinical information and data exchange, and assists in the development and implementation of strategic plans. It also collaborates with providers to develop and enhance practice engagement strategies for individual members. The specialist may become a Subject Matter Expert on specific provider types and provides on-site practice transformation support and education to Providers in the CareSource PCMH program, supporting the NCQA Patient Centered Medical Home model. Complex provider issues are resolved within 30 days or less. The role works with leadership and stakeholders to evaluate policy and process changes, monitors implementation, and provides leadership on provider-affecting initiatives. It ensures CareSource complies with regulatory requirements, addresses compliance concerns, achieves accreditation standards, and participates in market audits. Mentoring and training new hires is also a responsibility. This is a mobile position requiring regular travel, exposure to weather conditions, and potentially long periods of standing/sitting. Employees must reside in their assigned work territory, with exceptions considered. Travel may exceed 50% of the time. A valid driver's license, car, and insurance are necessary. Flexible hours, including evenings and weekends, may be required.

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. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment.
• 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

Nice To Haves

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

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
• 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.
• 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