Professions: Provider Engagement Consultant-Louisiana - Irving, Texas - (Irving, TX)

DescriptionPOSITION SUMMARYThe Provider Engagement Consultant develops integrated networks with quality providers yielding a geographically competitive, broadly accessible, stable network that achieves objectives for unit cost performance and trend management, and produces an affordable and predictable product for customers and business partners. Engagement Consultants evaluate and negotiate risk arrangements in compliance with company contract templates, reimbursement structure standards, and other key process controls. Responsibilities also include establishing and maintaining strong business relationships with an appropriate distribution of integrated provider specialties.This role evaluates practices in analyzing member care, trending quality compliance at the provider level, and developing action plans and programs to support provider practices in continuous quality improvement using approved clinical practice guidelines, HEDIS, CMS, NCQA and other tools.