Provider Specialist

Description

Join our award winning culture as we support members in your area! 

Position Summary:

The Provider Specialist develops and maintains a network of high quality and culturally competent service providers to meet members’ needs, negotiates rates for service provider contracts, monitors provider quality and contract compliance, and builds positive working relationships with service providers, community representatives, county departments, Interdisciplinary Team (IDT) staff, and others to develop and maintain contracts and community resources necessary to meet the needs of Lakeland Care Inc’s (LCI’s) population. 

Responsibilities & Competencies:

• Recruit new providers and promote expansion within the current provider network.
• Negotiate rates and creatively solve problems with providers to ensure a cost-effective, robust, and high-quality network of providers.
• Offer education and orientation to providers, hospital discharge planners and others including an overview of Lakeland Care and the Family Care program. Following contract completion, support new providers through regularly scheduled follow up.
• Establishes and maintains positive working relationships with service providers. Collaborates and meets with providers and LCI staff to understand service delivery and monitor quality. 
• In collaboration with the Provider Relations & Contracting Team, participate in External Quality Review (EQR) and Certification processes; assist with the quality improvement/quality assurance plan.
• Attend and assist in the coordination of residential and non-residential provider forums and other activities to educate providers on agency procedures, service delivery, and contract standards.  
• Facilitate service development for members relocating from institutional settings into the community using the Request for Proposal (RFP) process, when deemed appropriate.
• Attend professional meetings such as State work groups, State/Regional meetings, community provider association meetings, and others relating to scope of work as assigned. Train/update other members of the Provider Relations Team as appropriate
• Maintain a thorough understanding of regulations relating to Contracting and the DHS Contract.

Requirements

• Bachelor’s degree in a human service field, business related field, or equivalent combination of education and experience (includes knowledge, skills, and abilities). 
• Experience working with the population(s) served in the Family Care program preferred.  
• Strong financial analysis skills required.  
• Strong mediation and negotiation skills, including the demonstrated ability to successfully negotiate rates, are strongly preferred.  
• Knowledge of service provider industry, subcontracting, and licensing and regulatory systems beneficial.  
• Knowledge of network provider contracting in a managed care model is a plus. 
• Current driver’s license, acceptable driving record and proof of adequate insurance required. 

Acknowledgement:

This job posting describes the general nature and level of work performed by the individual assigned to this position and should not be interpreted as all inclusive and is subject to change by the employer as the needs of the employer and requirements of the position change.

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Our Mission

Empowering individuals. Strengthening communities. Inspiring futures.

Our Vision

To create a world we all want to live in.

Our Core Values

Kindness – We believe kindness is always possible and that no compassionate act is ever wasted.

Inclusion – We believe that open hearts and open minds are the only path to a brighter future.

Trust – We believe that honesty is still in style and that promises still have power.

Lakeland Care is a Top Workplace award winning Wisconsin-based non-profit organization that focuses on creating a world we all want to live in. With long-standing roots as a managed care organization (MCO), we provide long-term care services to eligible elders and individuals with physical and intellectual or developmental disabilities. 

We are an equal employment opportunity employer functioning under an Affirmative Action Plan. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law. We are an organization that participates in E-Verify.