Careers

Current openings:

Locations: 

  • Charlotte
  • Raleigh
  • Wilmington

Position Purpose: 

Reporting to the Senior Director, Provider Engagement -- Performance and Analytics, the Coordinator, Provider Engagement will perform initial health plan orientation and conduct ongoing educational outreach with a focus on improving quality and financial outcomes within the provider network

  • Conduct initial provider orientations as well as ongoing educational outreach for assigned providers
  • Assist providers in achieving pay-for-performance milestones
  • Generate and interpret reports for providers based on detailed HEDIS and/or HBR (Health Benefits Ratio) analysis and review provider performance by both quantitative metrics and qualitative factors
  • Create and communicate milestone documents, dashboards and success metrics
  • Provide status updates for providers regarding incentive agreements
  • Conduct site visits to improve quality and financial outcomes
  • Act as a liaison between the provider and the health plan ensuring a coordinated effort in improving financial and quality performance
  • Engage providers to solicit and build on their ideas/interests related to quality performance measurement
  • Collaborate with Care Management, Quality and others across the Health Plan and Network
  • Educate providers regarding policies and procedures related to referrals, claims submission, web site education, Electronic Health Records, Health Information Exchange, and Electronic Data Interface
  • Engage providers on Advanced Medical Home / Patient Centered Medical Home initiatives
  • Support Contracting duties as requested
  • Travel (local and overnight): up to 50%.

Qualifications:

  • Bachelor’s degree in related field preferred; or equivalent experience
  • 3+ years of project management, provider relations, health care operations, or medical management
  • Experience in Managed Healthcare or Medicaid/Medicare industry preferred.
  • Excellent written, oral, and presentation skills required.
  • Ability to work collaboratively with staff and contractors at all levels.
  • Well developed organizational skills and attention to detail
  • High proficiency with Microsoft Office products as well as communication productivity tools.
  • Current state driver’s license

To apply for this position, click here to link to the application portal.

Location:

Raleigh, NC

Position Purpose:

Coordinate and negotiate physician (individual providers, single-specialty, and multi-specialty groups) and ancillary service agreements that are in accordance with Carolina Complete Health Network, health plan and State guidelines.  This position reports to Manager, Network Services.

  • Recruit, develop, and maintain healthcare provider network plan for region and set of providers
  • Identify and initiate contact with potential providers.  
  • Negotiate contracts
  • Leads assigned negotiations (i.e., physician and ancillary) and ensure that negotiations result in the unit cost targets expected and meet the objectives of Carolina Complete Health Network.
  •  Facilitate and provide oversight to the provider set-up and contract configuration to ensure accurate claims adjudication. 
  • Evaluate and monitor providers’ performance standards and financial performance of contracts.
  • Coordinate with internal departments and contracted providers to implement and maintain contract compliance.
  • Maintain and update on a routine basis the contract organization’s database.
  • Assist with and track credentialing activities.
  • Facilitate the organization of provider focus groups. 
  • Coordinate with internal departments and contracted healthcare providers to implement and maintain contract compliance. 
  • May require 5 - 25% travel

Qualifications:

Education/Experience:

  • Bachelor’s degree in Healthcare Administration, Business Administration, Marketing, related field, or equivalent experience. 
  • 2+ years of contracting, provider relations or other related experience preferably in a healthcare, managed care, or insurance related environment.

To apply for this job, click here to link to the application:

Carolina Complete Health Network is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.