Provider Specialist; Brown); Home based Field

Description

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Under the direction of the Provider Relations Supervisor, the Provider Specialist develops, supports, and maintains a diverse, high-quality, culturally responsive provider network that meets the needs of Lakeland Care, Inc. (LCI) members. This position monitors network capacity and access to services, recruits and engages providers, and supports provider contracting and onboarding activities. The Provider Specialist fosters collaborative relationships with providers, community partners, county agencies, Interdisciplinary Team (IDT) staff, and other stakeholders to promote equitable access to quality services and supports.

The role also assists in maintaining provider contracts and community resources necessary to meet the diverse needs of LCI's member population.

Essential

Competencies:

• Recruits and develops new providers while supporting the growth of a high-quality, culturally responsive provider network that meets member needs.
• Supports provider onboarding and integration to strengthen network capacity and provider engagement.
• Provides clear, timely, and respectful education to prospective and in-network providers regarding contractual requirements, expectations, and obligations.
• Ensures provider contractual agreements are accurate, complete, and reflective of information maintained within the Electronic Provider Record.
• Monitors network adequacy and capacity and proactively addresses service gaps to ensure members have access to needed services and supports.
• Engages underutilized providers through ongoing outreach and relationship-building efforts to maximize provider participation and network effectiveness.
• Maintains accountability for assigned projects by managing priorities, meeting deadlines, and delivering results that support departmental and organizational objectives.
• Follows through on commitments and communications with providers and internal stakeholders, fostering trust, collaboration, and strong working relationships.
• Analyzes complex information, identifies key issues, risks, and opportunities, and exercises sound judgment in determining appropriate actions and priorities.
• Applies problem-solving in alignment with MCO contract compliance standards, to recruit, develop, and support member access to appropriate providers and services.
• Negotiates rates with providers to ensure a cost-effective, robust, and high-quality network of providers.
• Analyzes and resolves complex provider issues by identifying root causes and developing solutions aligned with Family Care requirements and contractual guidelines.
• Leads and facilitates provider-related meetings by setting clear agendas, guiding discussion, documenting key decisions, and ensuring timely follow-up on assigned actions.
• Provides prospective providers with a comprehensive overview of Lakeland Care and the Family Care program and facilitates provider education, training, and orientation to support successful partnerships and quality service delivery.
• Demonstrates sound judgment, prioritizes effectively, and focuses on information most critical to achieving positive outcomes for members, providers, and the organization.
• Delivers responsive, respectful, and solution-focused customer service through timely communication and consistent follow-through with providers and stakeholders.
• Proactively identifies and addresses business needs, opportunities, and challenges while fostering collaboration and continuous improvement.
• Participates in LCI's Annual Quality Review (AQR), Quality Review Team (QRT) meetings, and DHS audits, supporting quality assurance and quality improvement initiatives that enhance provider performance and member outcomes.
• Maintains a commitment to accuracy, accountability, and continuous learning to ensure high-quality service and build trust with providers, colleagues, and community partners.
• Builds productive working relationships through active listening, respectful communication, sound judgment, and collaborative problem-solving.
• Demonstrates empathy and respect for diverse perspectives and experiences, fostering an inclusive and supportive environment.
• Responds to provider and organizational needs with professionalism, diplomacy, and customer-focused service.
• Participates in professional development opportunities to maintain knowledge and effectiveness in assigned responsibilities.
• Shares knowledge, guidance, and resources with team members to support collaboration and…