Provider Engagement Specialist – San Diego County (Field Remote)
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AI Summary
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
Location: San Diego, CAPosition Type: Full-Time
About Alignment Health
Alignment Health was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships, and proprietary technologies, Alignment is committed to transforming health care one person at a time.
We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced professionals passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.
Position Summary
The Provider Engagement Specialist is responsible for developing and maintaining strong relationships with provider offices to improve network performance, enhance provider satisfaction, and support organizational growth. This role partners with providers on strategies to increase patient retention and growth while driving performance across key quality and utilization metrics. The Provider Engagement Specialist serves as the main point of contact for providers, offering education, support, and tools to achieve goals.
- Build and maintain collaborative relationships with providers and their staff to support growth, retention, and performance improvement.
- Partner with providers to improve performance on key performance indicators (KPIs), including but not limited to growth, retention, Annual Wellness Visits (AWVs), HEDIS gap closures, hospital and ER utilization, risk adjustment, and other quality indicators.
- Conduct initial provider onboarding and provide ongoing education on Alignment tools, clinical programs, PCP incentives, member benefits, Model of Care, compliance requirements, and organizational initiatives.
- Assist in the development of training and educational materials and tools. Create provider in-service and implementation packets.
- Facilitate and serve as a single point of resolution for provider issues, including UM, prior authorization, claims, encounter data, eligibility, provider rosters, and directory validation.
- Represent Alignment Health at provider meetings, trainings, and community events; document meeting minutes and action items as needed.
- Consistently utilize, update, and maintain department databases and tracking tools to ensure provider engagement activities, visits, and outcomes are documented and monitored.
- Negotiate and implement standard physician and ancillary agreements; obtain provider credentialing; use network database to track recruitment activity.
- Maintain weekly activity summaries and submit reports on a weekly basis.
- Attend and participate in all staff meetings as required.
- Perform special projects as assigned.
- Experience:
- Minimum two years of related experience and/or training, or equivalent combination of education and experience.
- Experience in provider relations/contracting within an HMO, IPA, medical group, or institutional provider setting required.
- Education:
- B.A./B.S. degree preferred or two years relevant experience.
- Other Requirements:
- Bilingual (English/Spanish) preferred.
- Organized, detail-oriented, and self-starter.
- Strong analytical, quantitative, and problem-solving skills.
- Excellent verbal and written communication skills.
- Relationship-builder and team player.
- Strong presentation skills with ability to address diverse audiences effectively.
- Proficient in Microsoft Office Suite (Word, Excel, PowerPoint).
- Ability to travel 80% or more by car routinely in assigned market; occasional air travel as needed.
- Maintenance of reliable transportation, valid driver’s license, and automobile insurance required.
- Flexibility to work extended hours as needed.
- Remote work available upon approval.
- Regularly required to sit, talk, hear, use hands to finger, handle, or feel.
- Frequently required to reach with hands and arms.
- Occasionally required to stand, walk, climb, balance, stoop, kneel, crouch, or crawl.
- Must occasionally lift and/or move up to 25 pounds.
- Specific vision abilities required include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.
*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.
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