Provider Engagement Specialist, Delegated Partnerships

CareSource • Mobile, MA

6d • Remote

About The Position

The Provider Engagement Specialist - Provider Delegation Performance is responsible for overseeing and improving the performance of delegated partnerships programs and act as the engagement lead for high value, strategic health partners. This role involves managing performance measure components, leading strategic initiatives, and collaborating with providers to enhance their performance and population health outcomes. The specialist will also ensure compliance with regulations and accreditation standards.

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.
• Experience with Medicaid and Medicare products and programs.
• Value-based program oversight and performance tracking.
• Experience working within FQHCs, Health and Human services providers or equivalent.
• Knowledge of Provider Network Management Processes & Services.
• Proven experience in program management and performance monitoring initiatives or relevant position.
• Working knowledge of project/program management practices.
• 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.
• 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.

Responsibilities

• Assume full management responsibility for all performance measure components, including end-to-end data collection, evaluation, and timely dissemination of reports to both internal teams and delegated providers.
• 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.
• Develop a deep understanding of all program measures and metrics to support delegated providers in interpreting performance data and meeting expectations.
• Collaborate with providers individually to create and monitor performance improvement plans, engaging internal subject matter experts as needed and ensuring accountability for baseline performance standards.
• 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.
• Generate monthly and quarterly performance and administrative reports, ensuring consistency, accuracy, and timely distribution to delegated providers. This includes reporting related to contracts, regulatory, NCQA and other requirements.
• Provide on-site practice transformation support and education to Providers identified as partners in the CareSource PCMH program.
• 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.
• 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