Provider Engagement Specialist III-North Eastern Mississippi

CareSource•Mobile, AL

32d•$64,980 - $103,950•Onsite

About The Position

TrueCare is a Mississippi non-profit, provider-sponsored health plan formed by a coalition of Mississippi hospitals and health systems throughout the state and supported by CareSource’s national leadership in quality and operational excellence. TrueCare offers locally based provider services through provider engagement representatives and customer care. Our sole mission is to improve the health of Mississippians by leveraging local physician experience to inform decision-making, aligning incentives, using data more effectively, and reducing friction between the delivery and financing of health care. By doing so, TrueCare will change the way health care is delivered in Mississippi. 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.

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. If the driver’s license record results are unacceptable, the offer will be withdrawn or, if you have started employment in this position, your employment in this position will be terminated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 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. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified. CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.

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. 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