BH Provider Engagement Specialist III

Commonwealth Care Alliance® (CCA) is a nonprofit, mission-driven health plan and care delivery organization designed for individuals with the most significant needs. As an affiliate of CareSource, a nationally recognized nonprofit managed care organization with over 2 million members across multiple states, CCA serves individuals enrolled in Medicaid and Medicare in Massachusetts through the Senior Care Options and One Care programs and its care delivery enterprises. CCA is dedicated to delivering comprehensive, integrated, and person-centered care, powered by its unique model of uncommon care®, which yields improved quality outcomes and lower costs of care.

Job Summary:

The Behavioral Health Provider Engagement Specialist III is responsible for provider contracting services, provider assistance and acts as the engagement lead for high value, strategic BH 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 Massachusetts 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

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, to include three 3 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 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

Licensure and Certification:

• 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.
• Six Sigma Certification or Project Management certification preferred
• Behavioral health credentials preferred

Working Conditions:

• Mobile Worker: This is a mobile position, meaning that regular travel to different work locations is essential. Will be exposed to weather conditions typical of the location and may be required to stand and/or sit for long periods of time.
• 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
• Required to use general office equipment such as a telephone, photocopier, fax machine, and personal computer
• Flexible hours, including possible evenings and/or weekends as needed to represent CareSource

Compensation Range:
$72,200.00 - $115,500.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. 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.

Compensation Type:
Salary

Competencies:
- Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.