Provider Engagement Account Manager

This is a fully remote position, open to applicants in Arizona.

📋 Description

• Foster and maintain relationships between the health plan and contracted provider networks.

• Cultivate client relations to guarantee the highest quality of care for members.

• Collaborate with providers to identify performance enhancement opportunities and solutions.

• Act as the primary point of contact and liaison between providers and the health plan.

• Address and resolve provider issues in coordination with internal partners.

• Handle external provider-related inquiries and concerns.

• Investigate, address, and communicate any provider claim issues and updates.

• Input changes to provider demographic information.

• Educate providers on referrals, claims submission, website navigation, EDI solicitation, and other pertinent topics.

• Conduct orientations for providers and ongoing educational sessions.

• Develop and revise orientation materials as needed.

• Oversee network performance within the designated territory.

• Assess provider performance and formulate strategic improvement initiatives.

• Foster enhancements in risk/P4Q, HBR, HEDIS/quality, cost, and utilization metrics.

• Undertake special projects and additional assigned responsibilities.

• Adhere to all relevant policies and standards.

⛳️ Requirements

• Candidate must reside in Mohave County.

• Bachelor’s degree in a relevant field or equivalent experience is required.

• Minimum of two years in managed care or medical group settings, including provider relations, quality improvement, claims, contracting, utilization management, or clinical operations.

• Experience in project management within a medical group, IPA, or health plan environment.

• Proficient in HEDIS/Quality measures, as well as cost and utilization analysis.

• Willingness to travel locally four days a week.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement programs.

• Paid time off along with holiday pay.

• Flexible work arrangements including remote, hybrid, field, or office schedules.

• Additional forms of incentives may be part of the overall compensation package.