Strategic Provider Engagement Specialist
6 days ago
We are seeking a skilled Strategic Provider Engagement Specialist to join our team at Blue Shield of California.
Job SummaryThis role will focus on developing and maintaining strong relationships with healthcare providers, driving value-based care initiatives, and ensuring seamless operations across our pay-for-value payment models.
Key Responsibilities- Implement effective strategies to improve provider performance and foster a collaborative working environment.
- Serve as a liaison between our organization and ACO/Advanced Primary Care provider support teams, resolving questions or issues related to the reporting platform.
- In the absence of dedicated provider support teams, work directly with providers to address contract interpretation, product/program implementation, and claims administration queries.
- Support providers and self-funded payer groups as they opt into pay-for-value payment models, providing training and internal & external reporting services.
- Ensure provider compliance with company policies and contractual agreements, identifying potential network participants and promoting provider participation in Blue Shield programs and networks to enhance our competitive position in the market.
- Conduct provider orientations, communicate company policies, procedures, products, or services, and lead onboarding sessions with clinical quality teams for new providers transitioning to pay-for-value payment models.
- Lead annual and other ad-hoc reviews with providers to demonstrate their performance on payment models and identify areas for improvement.
- Document and provide feedback from providers on payment models to drive improvements and reduce provider abrasion.
- A college degree or equivalent experience is required.
- At least 5 years of prior relevant experience is necessary.
- Experience working with pay-for-value payment models is preferred.
- Broad knowledge of project management is beneficial.
- An understanding of healthcare clinical quality is essential.
- Excellent analytical and problem-solving skills are required.
Blue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We strive to create a diverse, equitable, and inclusive environment where all employees can be their authentic selves and contribute fully to meet the needs of the multifaceted communities we serve.
Salary RangeThe estimated salary range for this role is $77,990 - $116,930 per year, depending on experience, location (California), and current employee salaries for similar roles.
BenefitsWe offer a hybrid workplace model, allowing you to decide where you can do your best work. Our office environment involves part-time to full-time schedules, and we're committed to making work-life balance a reality.
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