Health Partner Engagement Specialist II-Northern Nevada (Reno, Sparks)

Job Summary :

The Health Partner Engagement Specialist II collaborates with key Health Partners in the development of specific strategies for enhanced engagements. Health Partner engagement shall be measured by confidence in CareSource and affiliated Companies' ability to fulfill promises, integrity to make things right when problems occur, pride in working with CareSource, and their passion about CareSource being a vital member of the care team.

Essential Functions :

• Provide proactive, high-level account development and support in order to drive the overall satisfaction and engagement of key Health Partners
• Achieve the team business plan objectives, both in implementing new plans and in identifying and responding to customer needs
• Develop strong working relationships with key internal business partners
• Demonstrate the ability to handle, refer, or delegate complex or non-routine questions, issues, and problems to appropriate resources as they relate to the assigned accounts and ensure they are resolved in a timely manner. Timely is defined as 30 days or less.
• Refer routine Health Partner service issues, administrative functions, eligibility, and claims questions to appropriate internal departments
• Make on-site presentations to existing and prospective clients to educate and inform on CareSource products and report on key operational metrics
• Keep management informed of account status & opportunities for relationship enhancement & unresolved systemic issues
• Monitor and manage the achievement of customer specific performance guarantees to include operations, clinical, pharmacy, behavioral
• Identify internal procedures that adversely affect customer satisfaction and work with internal areas to build consensus to initiate improvements
• Maintain organized files & document all interactions in the Customer Relationship Management tool ("CRM")
• Coordinate with Clinical Practice Consultant and Case Management counterparts to ensure seamless service and consistent training
• Set targets and priorities in order to contribute towards meeting overall CareSource Network Strategy
• Support recruitment and contracting efforts by developing strong interpersonal relationships with providers, hospitals and ancillary providers
• Participate in the renegotiation of contracts utilizing detailed analysis of provider behaviors
• Facilitate and / or participate in all necessary committees and groups related to Health Partner engagement, quality and performance.
• Perform all necessary duties to successfully support CareSource and Affiliate Companies contractual requirements with state and any other regulatory entities
• Regular travel to conduct health partner visits and community based visits as needed to ensure effective administration of the program
• Perform any other job related instructions, as requested

Education and Experience :

Competencies, Knowledge and Skills :

Licensure and Certification :

Working Conditions :

Compensation Range :

$61,500.00 - $98,400.00 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 :

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.

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