Provider Engagement Consultant Job Description

Provider Engagement Consultant Job Description

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Provider engagement consultant provides training to provider groups on Medicare Advantage, quality measures (HEDIS) and risk adjustment.

Provider Engagement Consultant Duties & Responsibilities

To write an effective provider engagement consultant job description, begin by listing detailed duties, responsibilities and expectations. We have included provider engagement consultant job description templates that you can modify and use.

Sample responsibilities for this position include:

Educate providers on general policies and procedures applicable to delivery of care (e.g., regulatory
Advocate the use of Provider Tools, Online technology and health plan resources
Analyze data to determine root cause of issue (e.g., identify trends and patterns
Support member retention events/activities and health plan communal initiatives
Between projects, it's expected that this resource will also support internal development of offerings and external business development efforts
Analyzes business and user needs
Establishes, builds, and maintains positive working relationships with the providers and payers, their staff through conducting regular contact with and visits to provider sites along with setting up payer Joint Operating Committees (JOC) meetings
Creates operational and financial dashboards, scorecards and profiles and other operational and financial tools for successful administration of VBC or fee-for-services contracting
Keeps a pulse on provider and payer relation concerns and ensures all provider and payer issues are promptly reviewed and resolved and or/refers them to appropriate person continuing to track follow up to resolution
Responsible for communicating and educating providers on value-based contracts and engagement relationships with payers, TPAs, employers and payers

Provider Engagement Consultant Qualifications

Qualifications for a job description may include education, certification, and experience.

Education for Provider Engagement Consultant

Typically a job would require a certain level of education.

Employers hiring for the provider engagement consultant job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Master's Degree in Graduate, Business, Health Care, Network Management, MBA, Education, Science, Nursing, Finance, Associates

Skills for Provider Engagement Consultant

Desired skills for provider engagement consultant include:

Procedures and systems
Humana’s internal policies
Medicare
Claims processing systems and guidelines
Value based collaborations
HEDIS
HEDIS & Stars Measures
Microsoft Word & Excel
Excel and Access
HEDIS measures

Desired experience for provider engagement consultant includes:

Prior experience in provider relations or account management within health insurance
This role requires 50-75% local travel in the Central Tennessee area
This role requires 50-75% local travel in the Knoxville, TN area
3+ years of expertise in a number of network related areas, including negotiation and contracting, provider engagement, provider performance management, payment innovation, provider data management, and network operations and/or overall network management
2+ years of network management experience with value based agreements and/or (ACO, PCMH, bundled payments, and/or risk sharing arrangements)
Bachelor's degree or RN preferred

Provider Engagement Consultant Examples

1

Provider Engagement Consultant Job Description

Job Description Example
Our company is looking for a provider engagement consultant. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for provider engagement consultant
  • Ensures policies are developed as appropriate for areas of responsibility and that the processes are developed and maintained to adhere to these policies
  • Conduct regular visits to providers to introduce new initiatives and monitor success of those in place and to identify issues and ensure effective problem resolution to maintain strong relationships
  • Works with the team to ensure features, stories, and tasks are entered, maintained, and tracked in required Agile tooling solutions
  • Partner with the provider community to develop the capability for sustained, integrated consumer interaction programs building consumer advocacy and loyalty
  • Influence provider culture and strategy to elevate the capability of the provider community to support the ever-changing healthcare environment
  • Need to work independently and within an integrated team in a highly matrixed environment
Qualifications for provider engagement consultant
  • Clinical background and/or MBA not required but a plus
  • Must reside in West Tennessee
  • 50% of local travel may be required
  • Must reside in Alexandria, LA or within a commutable distance
  • 5 years provider engagement or network management experience preferred
  • Must reside in Colorado Springs or within commutable distance
2

Provider Engagement Consultant Job Description

Job Description Example
Our innovative and growing company is looking for a provider engagement consultant. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for provider engagement consultant
  • Registered Nurse with no restrictions in state required to practice
  • Prior experience in physician offices or working with providers
  • Must reside in Layfayette, LA or within a commutable distance
  • Includes Travel in Dothan, AL area
  • Excellent skills working with a team
  • Experience with ACO, Risk-Based, Value-Based Contracting highly desireable
Qualifications for provider engagement consultant
  • Bachelor’s Degree or RN designation required
  • RN or LPN designation preferred
  • Bachelor Degree and 4 years experience in strategic planning, market research, product development or network management in health care industry OR Masters/Professional Degree and 3 year of experience strategic planning, market research, product development or network management in health care industry OR 6 year of experience strategic planning, market research, product development or network management in health care industry
  • Ability to drive consensus and influence at various levels of the organization
  • Verbal and written communications skills including interpersonal communication skills to work across departments, present findings and status of projects, build relationships and garner information from various sources
  • Experience interacting with staff/management across multiple departments and levels
3

Provider Engagement Consultant Job Description

Job Description Example
Our innovative and growing company is looking to fill the role of provider engagement consultant. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for provider engagement consultant
  • 1+ years of experience in provider relations and network communications and interactions
  • 1+ years of healthcare, managed care or marketing experience
  • Able to work core business hours, Monday - Friday, 40 hours
  • Work overtime, weeknights and weekends, as required
  • Travel up to 75% of the time within assigned sales territory
  • Access to reliable transportation with valid driver’s license that will enable you to travel to client and/or sites within designated area
Qualifications for provider engagement consultant
  • Requires strong relationship building skills with physicians, office staff, payers and members of the healthcare network
  • Must be able to work independently in both an organizational start up mode growth and maintenance mode
  • Must be highly organized and able to manage multiple projects, dashboards, and multiple high-level priorities
  • Communicates clearly and effectively in written and verbal conversations
  • Works under short deadlines, is flexible, open to change based on leadership dialog
  • Knowledge of the managed care/value-based healthcare industry preferred
4

Provider Engagement Consultant Job Description

Job Description Example
Our innovative and growing company is looking for a provider engagement consultant. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for provider engagement consultant
  • 5 years of provider engagement or network management experience preferred
  • Reside in Eastern or Central Time zone
  • Bachelor’s Degree in Nursing, Science or equivalent work experience
  • Current unrestricted nursing licensure required in Kentucky
  • Travel to physician offices within the Kentucky up to 75% of the time
  • Registered Nurse with current unrestricted Massachusetts state license
Qualifications for provider engagement consultant
  • Reside in Corpus Christi , TX
  • Proficiency in CMS marketing rules and regulations
  • 6+ years related work experience in Network Management, Network Operations and or Provider Relations- equivalent combination of transferable experience and education
  • Related Bachelor’s degree or additional related equivalent work experience
  • 5+ years Network Management, Network Operations and or Provider Relations work experience or equivalent combination of transferable experience and education
  • 2+ years’ experience utilizing financial models and analysis in negotiating rates with providers
5

Provider Engagement Consultant Job Description

Job Description Example
Our innovative and growing company is looking to fill the role of provider engagement consultant. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for provider engagement consultant
  • Ability to identify opportunities to improve performance and develop strategies to facilitate change
  • Ability to effect change, perform critical analysis, plan and organize effectively and support needs of medical group
  • Demonstrate proficiency in use of job related technology applications
  • Must be able to prioritize and manage multiple projects simultaneously
  • Requires initiative, sound judgment, and the ability to work under pressure in a constantly changing environment balancing multiple priorities and utilizing resources aggressively
  • Requires strong verbal and written communication skills to effectively communicate
Qualifications for provider engagement consultant
  • Consulting experience with Medical Groups highly desirable
  • Experience in outpatient physician practice management preferred
  • Experience in medical case management/discharge planning/project management highly desirable
  • Experience in the use of PC based systems is essential
  • Possess knowledge and experience in effective care management for the senior population balancing quality with cost effective management interventions
  • Ability to identify and manage multiple complex issues in a flexible and professional manner

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