Provider Engagement Specialist (Field-Based)

Provider Engagement Specialist (Field-Based)

Overview: The Provider Engagement Specialist supports the performance and growth objectives of the assigned market by building strong relationships with primary care and specialist providers. This role is responsible for provider outreach, education, contracting support, and ongoing network operations to drive quality outcomes and improve provider performance.

Key Responsibilities

• Build and maintain collaborative relationships with providers, office staff, and key stakeholders to support network growth and performance.

• Conduct provider onboarding, orientations, and ongoing education initiatives.

• Perform regular in-person provider visits to review performance metrics and identify improvement opportunities.

• Analyze provider performance data and deliver actionable insights to optimize outcomes.

• Educate providers on HEDIS, Stars, Risk Adjustment, and documentation/coding requirements.

• Develop and implement provider engagement strategies to improve quality scores and member experience.

• Support resolution of provider issues related to access, claims, eligibility, and utilization management

• Create and deliver training materials, in-service presentations, and Model of Care trainings.

• Maintain accurate provider data and activity tracking in Salesforce and internal systems.

• Support provider recruitment, contracting, and credentialing processes

• Negotiate and implement provider agreements in assigned markets.

• Track recruitment and contracting activity and provide regular reporting.

• Serve as a primary point of contact for provider inquiries, ensuring timely resolution.

• Participate in team meetings and contribute to special projects as needed.

• Exercise independent judgment and decision-making on complex issues with minimal supervision.

Experience

• Required: Minimum 1 year of experience in provider relations, contracting, or network management within an HMO, IPA, medical group, or healthcare organization

• Preferred: 2 years of provider-facing experience, including Medicare lines of business

• Strong understanding of HEDIS, Stars, Risk Adjustment, and MLR

Education

• Required: High School Diploma or GED (bachelor’s degree or equivalent experience preferred)

• Preferred: MBA

Skills & Competencies

• Strong communication and relationship-building skills

• Ability to present complex healthcare topics to providers

• Proficiency in Microsoft Office (Word, Excel, PowerPoint)

• Strong analytical, problem-solving, and organizational skills

• Ability to manage multiple priorities in a fast-paced environment

• Experience analyzing and interpreting performance data and reports

Licensure & Requirements

• Valid driver’s license required

• Reliable transportation and current automobile insurance required

Work Environment & Travel

• Up to 80% travel by car within the assigned market

• Occasional air travel as needed

• Ability to work extended hours when necessary

• Remote work available with approval

Physical Requirements

• Regularly required to sit, stand, walk, and use hands for tasks.

• Ability to lift to 10 pounds occasionally

• Close vision and focus adjustment required

Why This Role

This is an opportunity to take ownership of a territory, build meaningful provider relationships, and directly impact healthcare quality and outcomes. You’ll be in the field, making decisions, and driving real change — not sitting behind a desk pushing paperwork.

Interested in Learning More?

Apply directly or reach out to discuss the opportunity in more detail.