Provider Engagement Specialist III- Mississippi- Central West and Coastal Region

Job Summary Provider Engagement Specialist III is responsible for provider contracting services, provider assistance, and acts as the engagement lead for high‑value, strategic health partners. Essential Functions Execute the quality, engagement, and contracting strategy. Develop provisions based on cost, quality/analysis and monitor key metrics for the assigned Market Lead. Support overall network performance, new products, and product expansion. Recruit, contract, and initiate loading and credentialing processes and ensure timely and appropriate loading. Coordinate the account strategy and provide account support to drive provider satisfaction and engagement. Negotiate and re‑negotiate hospital, ancillary, physician, and behavioral health contracts, terms, reimbursement rates, etc., in compliance with corporate policies. Analyze financial data to establish network strategic initiatives, partnerships, and rates in collaboration with leadership and Finance. Be 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 Joint Operating Committees with key health partners and present data on provider performance. Enhance providers’ population health through member health outcome and quality improvement techniques. Collaborate with the Population Health Analytics team in coordinating the exchange of clinical information and member/population level data. Assist in developing and implementing strategic plans in collaboration with leadership and the Population Health Analytics team. Collaborate with providers to develop and enhance the practice’s engagement strategies for individual members. Act as a subject‑matter expert on specific provider types as requested. Provide on‑site practice transformation support and education to providers identified as partners in the CareSource PCMH program. Resolve complex or non‑routine provider questions, issues, and problems within 30 days or less and communicate as needed. Work with leadership and stakeholders to evaluate policy and process changes for potential provider impacts, monitor implementation of key initiatives, and provide leadership on initiatives affecting providers. Ensure compliance with regulatory requirements, address compliance concerns, achieve accreditation standards, and participate in market audits. Mentor and/or train new hires. Perform any other job duties as requested. Education and Experience Bachelor’s degree in a healthcare‑related field, or equivalent years of relevant work experience is required. Master’s Degree is preferred. Minimum of five (5) years of healthcare experience, including three years of direct work experience in provider relations and/or provider contracting. Managed care experience is required. NCQA PCMH experience is preferred. Competencies, Knowledge and Skills Intermediate proficiency in 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. Licensure and Certification Employment is conditional pending successful clearance of a driver’s license record check. Influenza vaccination is required; annual proof of vaccination is required during influenza season (October1–March31). Six Sigma Certification or Project Management certification preferred. Working Conditions Mobile position: regular travel to different work locations is essential. May be required to travel greater than 50% of the time. A valid driver’s license, car, and insurance are necessary for travel. Exposed to typical weather conditions; may need to stand and/or sit for long periods. Required to use general office equipment such as telephone, photocopier, fax machine, and personal computer. Flexible hours, including possible evenings and/or weekends as needed. Compensation $64,980.00 – $103,950.00. The compensation range is based on education, training, and experience as well as the position’s scope and complexity. In addition to base compensation, employees may qualify for a bonus tied to company and individual performance. Equal Opportunity Employment CareSource is an Equal Opportunity Employer. The company is dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #J-18808-Ljbffr