Provider Engagement and Performance Specialist III

Job Summary

5 Positions Available:

The Provider Engagement and Performance Specialist III serves as the day‑to‑day steward of a defined portfolio of provider relationships, ensuring a consistent communication cadence, timely issue resolution, and measurable performance improvement across value‑based programs.

This position translates organizational priorities into actionable engagement plans by implementing provider protocols, tracking operational and quality metrics, and facilitating information between provider partners and internal teams to ensure partnership objectives are met and sustained.

The Provider Engagement and Performance Specialist III manages complex assignments, analyzes and synthesizes data to identify trends and actionable insights, and proactively communicates risks, opportunities, and recommendations to leadership. Acts as a Subject Matter Expert (SME), serves as a resource and mentor for other staff.

Duties

Leads comprehensive provider engagement cycles from planning and communication through execution, documentation, follow-up, and continuous improvement.

Maintains ongoing communication and relationships with assigned providers, structures and facilitates partnership meetings, and documents outcomes, action items, and follow-up activities. Supports the implementation of value-based care initiatives by monitoring progress against contractual and program benchmarks, preparing performance and analytic reports for leadership, and ensuring provider engagement activities are compliant with applicable regulatory standards.

Serves as a liaison across teams and key stakeholders to coordinate initiatives that address performance gaps and improve member and provider experience. Assists with provider orientations and targeted trainings. Supports credentialing/re‑credentialing activities and member complaint investigations. Resolves escalated provider inquiries. Maintains accurate provider information and monitors timely submission of contractually required reports. Analyzes network metrics to assess network adequacy, identify performance trends, and recommend corrective actions when standards are not met.

Translates complex policies and operational changes into concise provider communications. Coordinates implementation activities. Tracks action items and commitments. Monitors progress and timelines, and communicates status and outstanding issues to stakeholders to ensure timely and effective implementation.

Applies subject matter expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, provides mentorship, and contributes specialized knowledge. Ensures facts and details are correct so that the program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training and recommends process improvements as needed.

Performs other duties as assigned. 

Duties Continued

Education Required

Education Preferred

Experience

Required:

At least 4 years of experience in managed care or related provider‑facing roles, with demonstrated experience coordinating cross‑functional initiatives and using data to improve outcomes.

Experience in managed care contracting and analysis.

Preferred:

Experience mentoring peers and managing complex provider portfolios and escalations.

Experience leading provider trainings, developing targeted communications, and resolving complex operational or payment issues.

Skills

Required:

Advance written and verbal communication skills.

Strong strategic key stakeholder management skills.

Ability to manage multiple projects, document decisions, and follow through on action items.

Ability to analyze operational and performance data, draw insights, and produce concise reports to inform decisions.

Knowledge of managed care contracts and provider contracting fundamentals.

Proficient with office productivity tools (e.g., Microsoft Office) for analysis, presentation, and stakeholder updates.

Attention to detail skills, with the ability to handle multiple tasks.

Preferred:

Advanced knowledge of provider data management, directory standards, and regulatory reporting workflows.

Knowledge of medical coding frameworks (e.g., ICD‑10, CPT) to interpret claims and performance trends and partner on corrective actions.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information

Required:
Travel to offsite locations for work required.