Health Partner Engagement Specialist II-Northern Nevada

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:

• Bachelor of science/arts degree in communications, business or related industry or equivalent years of relevant work experience is required
• Master Degree preferred
• Five or more years of healthcare industry, account management or sales experience
• Demonstrated ability to develop and grow relationships in complex healthcare organizations

Competencies, Knowledge and Skills:

• Proven relationship development skills
• Strong proficiency level with Microsoft Word, Excel, Outlook
• Knowledge of managed care principles, benefit design, claims processing, finance, data reporting design, and analysis
• Proven leadership and mentoring experiences
• Strong written and verbal communication and presentation skills
• Excellent organizational and time management skills
• Ability to prioritize
• Strong interpersonal skills
• Demonstrated strategic thinking and planning skills
• Excellent research and analytical skills
• Marketing competencies

Licensure and Certification:

• Employment in this position is conditional pending successful clearance of a driver’s license record check.  If the driver’s license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in the position will be terminated
• To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verifi