Provider Engagement & Practice Transformation Specialist

Harris Health System, Inc.; Houston (TX); Hybrid; USD 65,000 - 85,000; Full time

Job summary

Community Health Choice, Inc. (Community) seeks a Provider Engagement Manager to build and maintain partnerships with providers, physicians, and facilities.

This field-based role supports new initiatives, access and availability, prior authorizations, claims issues, and the Provider Portal, owning an assigned provider portfolio. The position focuses on provider education, issue follow-up, practice improvement, scorecard delivery, and accurate provider information, with travel about 75% and a

Qualifications

• Education/Specialized Training/Licensure: High school diploma or equivalent required.
• Bachelor's degree in Business, Healthcare Administration, or a related field preferred.
• Three (3) years of provider engagement, provider account management, provider contracting, practice management, or related healthcare experience.
• Experience in a Managed Care Organization or health plan environment.
• Proficiency with Microsoft Office applications and web-based technologies.
• Salesforce and QNXT.
• Travel is required approximately 75% of the time. Access to a vehicle and a valid Texas driver's license are required.
• Strong provider relations skills and understanding of risk and value-based contracting.
• Familiarity with fee-for-service, capitation, global budget, performance compensation, and episode-of-care payment methods; knowledge of Member and practice risk adjustment mechanics and premium-based payment methodologies.

Responsibilities

• Serve as the primary point of contact for Community partners interfacing with the provider practice and its staff, engaging them as needed to support practice improvement.
• Own post-recruitment phase of the practice cycle and support implementation of assigned initiatives.
• Support alignment of practice operations with key elements of Community's Care Model.
• Provide field-based and telephonic education on relevant operational topics.
• Facilitate training in cultural care, HEDIS, STARS, and other applicable departmental topics.
• Establish a regular meeting cadence with assigned provider practices to support practice transformation and improvement activities.
• Develop and support improvement plans measured by cost, quality outcomes, provider satisfaction, HEDIS and STARS performance, contract goals, and value-based activities.
• Support Quality and Population Health strategies and help ensure contractual requirements are implemented at the practice level.
• Deliver operational reports and scorecards to providers, using data analysis to communicate remediation opportunities and influence practice changes.

Skills

Provider engagement

Provider relations

Practice management

Travel readiness

Education

High school diploma

Bachelor's degree in Business or Healthcare Administration

Tools

Salesforce

QNXT

Microsoft Office

Job description

Community Health Choice, Inc. (Community) seeks a Provider Engagement Manager to build and maintain partnerships with providers, physicians, and facilities.

This field-based role supports new initiatives, access and availability, prior authorizations, claims issues, and the Provider Portal, owning an assigned provider portfolio. The position focuses on provider education, issue follow-up, practice improvement, scorecard delivery, and accurate provider information, with travel about 75% and a