Provider Engagement Specialist III-North Eastern M

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.Essential Functions:Execute the quality, engagement, and contracting strategy, develop provisions based on cost, quality/analysis and monitor key metrics for the assigned MarketLead for identified Market performance and engagement strategic initiatives under the direct supervision of their managerMarket lead for performance and engagement activities to support overall network performance, new products, and product expansionResponsible for provider recruitment, contracting and initiating the loading and credentialing processes and ensuring timely and appropriate loadingCoordinate the account strategy and provide account support with the goal of driving the overall satisfaction and engagement of Provider networkNegotiate and re-negotiate hospital, ancillary, physician and behavioral health contracts, terms, reimbursement rates, etc., in a manner that complies with corporate policiesAnalyze financial data to establish network strategic initiatives, partnerships, and to establish rates in collaboration with leadership and FinanceKnowledgeable of federal and state laws and regulations pertaining to provider contractingDrive quality outcomes through execution and support of Value Based Reimbursement agreements with providersAssume leadership role in JOC's (Joint Operating Committees) with key health partners and be able to develop and present data on Provider performanceEnhance effectiveness of Providers' population health through a variety of member health outcome and quality improvement techniquesCollaborate with Population Health Analytics team in coordinating the exchange of clinical information and member/population level dataAssist in development and implementation of strategic plans in collaboration with leadership and population health analytics teamCollaborate with the Provider to develop and enhance the practice's engagement strategies for individual membersAs requested, become a Subject Matter Expert on specific provider typesProvide 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 neededWorks 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 providersEnsures CareSource complies with regulatory requirements, addresses compliance concerns, achieves accreditation standards, and participates in market auditsMentor and/or train new hiresPerform any other job duties as requestedEducation and Experience:Bachelor's degree in a healthcare related field, or equivalent years of relevant work experience is requiredMaster's Degree is preferredMinimum of five (5) years of healthcare experience, to include three 3 years of direct work experience in provider relations and/or provider contractingManaged care experience is requiredNCQA PCMH experience is preferredCompetencies, Knowledge and Skills:Intermediate proficiency level with Microsoft Outlook Word, and ExcelKnowledge of Provider Network Management Processes & ServicesAbility to manage and prioritize multiple tasks, promote teamwork and fact-based decision makingStrong negotiation skillsEffective oral and written communication skillsCritical listening and thinking skillsTraining/teaching skillsTime management skillsLicensure 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 terminatedTo 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 preferredWorking 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 needMay 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 travelRequired to use general office equipment such as a telephone, photocopier, fax machine, and personal computerFlexible hours, including possible evenings and/or weekends as needed to represent CareSourceCompensation Range:$64,980.00 - $103,950.00 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 pensation Type:SalaryCompetencies:- Fostering a Collaborative Workplace Culture- Cultivate Partnerships- Develop Self and Others- Drive Execution- Influence Others- Pursue Personal Excellence- Understand the BusinessThis 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.#LI-TS1CareSource is an equal opportunity employer and gives consideration for employment to qualified applicants without regard to race, color, religion, sex, age, national origin, disability, sexual orientation, gender identity, genetic information, protected veteran status or any other characteristic protected by applicable federal, state or local law.

Created: 2026-01-30