CareSource · 17 hours ago
Provider Engagement Specialist III-North Eastern Mississippi
Mississippi Mobile
Full-time
Onsite
Senior Level
$65K/yr - $104K/yr
5+ years expCareSource is a non-profit health plan formed by a coalition of Mississippi hospitals and health systems. The Provider Engagement Specialist III is responsible for provider contracting services, assisting providers, and leading engagement with strategic health partners to improve healthcare delivery in Mississippi.
Health CareMedicalNon Profit
Responsibilities
Execute the quality, engagement, and contracting strategy, develop provisions based on cost, quality/analysis and monitor key metrics for the assigned 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
Qualification
Required
Bachelor's degree in a healthcare related field, or equivalent years of relevant work experience is required
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
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
Employment in this position is conditional pending successful clearance of a driver's license record check
To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position
Mobile Worker: This is a mobile position, meaning that regular travel to different work locations is essential
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
Preferred
Master's Degree is preferred
NCQA PCMH experience is preferred
Six Sigma Certification or Project Management certification preferred
Benefits
You may qualify for a bonus tied to company and individual performance
Substantial and comprehensive total rewards package
Company
CareSource
CareSource provides managed care services to Medicaid beneficiaries.
1001-5000 employees
H1B Sponsorship
CareSource has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (30)
2024 (39)
2023 (35)
2022 (21)
2021 (37)
2020 (28)
Funding
Current Stage
Late StageTotal Funding
unknownKey Investors
FHLB Cincinnati
2026-01-17Grant
Leadership Team
Erhardt Preitauer
President & Chief Executive Officer
Jason Bearden
Market President and CEO, Georgia
Recent News
2026-01-18
Dayton Daily News
2025-12-17
Company data provided by crunchbase