Provider Engagement Consultant- TYLER

POSITION SUMMARY

The Provider Engagement Consultant develops integrated networks with quality providers yielding a geographically competitive, broadly accessible, stable network that achieves objectives for unit cost performance and trend management, and produces an affordable and predictable product for customers and business partners. Engagement Consultants evaluate and negotiate risk arrangements in compliance with company contract templates, reimbursement structure standards, and other key process controls. Responsibilities also include establishing and maintaining strong business relationships with an appropriate distribution of integrated provider specialties.

This role evaluates practices in analyzing member care, trending quality compliance at the provider level, and developing action plans and programs to support provider practices in continuous quality improvement using approved clinical practice guidelines, HEDIS, CMS, NCQA and other tools. We are building integrated and accountable networks in LA, TX, and NM. Under the supervision of the VP Provider Network Operations, this position is responsible for the continual development, management, and maintenance of relationships with physicians, providers and practice managers within an assigned provider network.

MAJOR RESPONSIBILITIES

• Market based point of contact for Health Plan and ACO participating providers
• Develop and maintain collaborative provider relationships that facilitate provider engagement, integration, and path to value arrangements.
• Partner with the provider community to develop capability for sustained, integrated consumer interaction programs building consumer advocacy and loyalty.
• Influence provider culture and strategy to elevate capability of the provider community to support the ever changing healthcare environment.
• Manage provider engagement/risk continuum, prospecting potential providers for value based opportunities
• Apply network configuration and incentive - based payment models as appropriate to improve quality and efficiency
• Leverage financial and utilization data with physicians and healthcare executives to provide actionable goals and opportunities to reduce expenses for providers with a shared savings opportunity
• Facilitate clinical education, leveraging clinical experience from your internal partners
• Work to develop and improve EMR capability.
• Partner with internal stakeholders to create a seamless experience for providers
• Travel requirement 90%.

POSITION QUALIFICATIONS

B. Experience

• 5 years provider engagement or network management experience preferred
• Prior experience working with Medicare and/or commercial products is highly desirable
• Experience with ACO, Risk-Based, Value-Based Contracting highly desirable.

C. Licenses, Registrations, or Certifications:

• Driver's License