Provider Specialist (Brown) (Home based with Field Travel)

Lakeland Care•DePere, WI

8h•Hybrid

About The Position

Under the direction of the Provider Relations Supervisor, the Provider Specialist develops, supports, and maintains a diverse, high-quality, culturally responsive provider network that meets the needs of Lakeland Care, Inc. (LCI) members. This position monitors network capacity and access to services, recruits and engages providers, and supports provider contracting and onboarding activities. The Provider Specialist fosters collaborative relationships with providers, community partners, county agencies, Interdisciplinary Team (IDT) staff, and other stakeholders to promote equitable access to quality services and supports. The role also assists in maintaining provider contracts and community resources necessary to meet the diverse needs of LCI's member population.

Requirements

Bachelor’s degree in a human service or business-related field, or equivalent combination of education and experience (including knowledge, skills, and abilities).
Experience working with individuals served in the Family Care program preferred.
Knowledge of provider network operations, subcontracting, and licensing and regulatory systems beneficial.
Knowledge of network provider contracting in a managed care model.
Current driver’s license, acceptable driving record, and proof of adequate insurance required.

Responsibilities

Recruits and develops new providers while supporting the growth of a high-quality, culturally responsive provider network that meets member needs.
Supports provider onboarding and integration to strengthen network capacity and provider engagement.
Provides clear, timely, and respectful education to prospective and in-network providers regarding contractual requirements, expectations, and obligations.
Ensures provider contractual agreements are accurate, complete, and reflective of information maintained within the Electronic Provider Record.
Monitors network adequacy and capacity and proactively addresses service gaps to ensure members have access to needed services and supports.
Engages underutilized providers through ongoing outreach and relationship-building efforts to maximize provider participation and network effectiveness.
Maintains accountability for assigned projects by managing priorities, meeting deadlines, and delivering results that support departmental and organizational objectives.
Follows through on commitments and communications with providers and internal stakeholders, fostering trust, collaboration, and strong working relationships.
Analyzes complex information, identifies key issues, risks, and opportunities, and exercises sound judgment in determining appropriate actions and priorities.
Applies problem-solving in alignment with MCO contract compliance standards, to recruit, develop, and support member access to appropriate providers and services.
Negotiates rates with providers to ensure a cost-effective, robust, and high-quality network of providers.
Analyzes and resolves complex provider issues by identifying root causes and developing solutions aligned with Family Care requirements and contractual guidelines.
Leads and facilitates provider-related meetings by setting clear agendas, guiding discussion, documenting key decisions, and ensuring timely follow-up on assigned actions.
Provides prospective providers with a comprehensive overview of Lakeland Care and the Family Care program and facilitates provider education, training, and orientation to support successful partnerships and quality service delivery.
Demonstrates sound judgment, prioritizes effectively, and focuses on information most critical to achieving positive outcomes for members, providers, and the organization.
Delivers responsive, respectful, and solution-focused customer service through timely communication and consistent follow-through with providers and stakeholders.
Proactively identifies and addresses business needs, opportunities, and challenges while fostering collaboration and continuous improvement.
Participates in LCI's Annual Quality Review (AQR), Quality Review Team (QRT) meetings, and DHS audits, supporting quality assurance and quality improvement initiatives that enhance provider performance and member outcomes.
Maintains a commitment to accuracy, accountability, and continuous learning to ensure high-quality service and build trust with providers, colleagues, and community partners.
Builds productive working relationships through active listening, respectful communication, sound judgment, and collaborative problem-solving.
Demonstrates empathy and respect for diverse perspectives and experiences, fostering an inclusive and supportive environment.
Responds to provider and organizational needs with professionalism, diplomacy, and customer-focused service.
Participates in professional development opportunities to maintain knowledge and effectiveness in assigned responsibilities.
Shares knowledge, guidance, and resources with team members to support collaboration and continuous improvement.
Serves as the primary contact for prospective and contracted providers, managing inquiries, outreach, and engagement activities.
Develops and maintains collaborative relationships with providers, community partners, and stakeholders to support service coordination, problem resolution, and network development.
Builds provider partnerships through responsive communication, transparency, and consistent follow-through.
Assists in coordinating provider forums and educational events to communicate agency procedures, service delivery expectations, and contract requirements.
Attends and assists in the coordination of provider forums and other activities to educate providers on agency procedures, service delivery, and contract standards.
Represents LCI at provider-focused meetings, networking events, and conferences to support provider recruitment and engagement.
Partners with IDT staff to address provider-related needs, share available resources, and support understanding of provider services and expertise.
Demonstrates LCI's values of Kindness, Inclusion, and Trust in all interactions with providers, members, colleagues, and community partners.
Recognizes the impact of provider network decisions on member outcomes and acts with integrity, compassion, and respect.
Fosters an inclusive environment by valuing diverse perspectives, experiences, and contributions.
Maintains confidentiality and exercises sound judgment when handling sensitive information and provider relationships.
Promotes positive and collaborative relationships with providers and stakeholders through professionalism, empathy, and exceptional customer service.
Represents LCI in a manner consistent with its mission, values, and commitment to quality outcomes.
Contributes to organizational success through collaboration, knowledge sharing, constructive feedback, and continuous improvement efforts.