Provider Experience Administrator - West NC presso Carolina Complete Health Network

Location: Asheville/Western, NC. This is primarily a remote position and we are currently targeting NC residents close to (or willing to travel frequently to) Asheville/Western NC.

About CCHN: Carolina Complete Health Network was founded in 2016 and is North Carolina’s only Physician-Led Medicaid Plan (also known as a Provider Led Entity). It’s the result of a collaborative joint venture between the NC Medical Society, the NC Community Health Center Association, and Centene Corporation.  We give medical care providers and Federally Qualified Health Centers (FQHC) a voice in policymaking which ultimately results in better patient outcomes, helping patients get the care they need when they need it through local, regional, and community based resources.   

Position Purpose: The Provider Engagement Administrator plays a pivotal, people-centered role in strengthening partnerships across Carolina Complete Health Network. Reporting to the Provider Engagement Supervisor, this position is the frontline connection between the health plan and our diverse network of providers—including hospital systems, local health departments, and advanced medical homes. With a focus on collaboration, education, and performance, the Provider Engagement Administrator travels regularly to engage providers, foster meaningful relationships, and support them in delivering high-quality, value-based care. As a trusted resource and advocate, the Provider Engagement Administrator helps drive satisfaction, performance, and innovation across the network.  

Key Responsibilities

• Act as a liaison between the provider (Hospital Systems, AMH, Local Health Department and Specialists) and the health plan ensuring a coordinated effort in improving financial and quality performance 

• Engage providers by soliciting and building 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. 

• Conduct initial provider orientations as well as ongoing educational outreach for assigned providers, covering topics including but not limited to Portal use training, CAP report retrieval, Quality Dashboards, and Claims lookup.  

• Identify and deliver solutions to solve significant problems for providers; quantify impact. 

• 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, as well as provide status updates regarding incentive agreements.  

• Conduct site visits to deepen the collaboration between the provider and the plan(s), build positive relationships, and improve upon their quality and financial outcomes, all while giving the provider a voice and ensuring they feel heard.  

• Collaborate with the Medical Policy Department and others to support policy development and ongoing assessment through provider engagement and other means 

• Protect confidential and sensitive business information, complying with Centene in NC firewall system, HIPAA, and CCHN partners 

• Perform other duties as delegated 

• May require up to 50% travel (local and overnight) 

Skills and 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 

• Ability to multitask, prioritize work and adapt to changing priorities 

• Must be a self-starter and have a strong sense of urgency 

• Should have a strong customer service mindset for supporting both and internal and external customers 

• Current state driver’s license 

• Reliable transportation (we reimburse for mileage and other travel-related costs) 

• Reliable high-speed internet and the ability to work effectively and independently in a remote setting.  

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.

CCHN Benefits

We offer a comprehensive benefits plan to help you care for you and your family's wellbeing:

• Medical, Dental, and Vision insurance plan offerings with a portion of premiums covered by CCHN (HSA and FSA eligible plans available!)

• Short/Long Term Disability and Supplemental Life Insurance included, as well as add-on options

• Annual wellness reimbursement

• 401k with company match

• Paid parental leave

• Paid time off

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.