Provider Engagement Account Manager

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

📋 Description

• Sustain collaborations between the health plan and contracted provider networks.

• Foster client relationships to ensure the highest quality of care for members.

• Engage with providers regarding performance optimization opportunities and solutions.

• Oversee consultative account management and take responsibility for resolving issues.

• Enhance performance in contract incentive metrics, quality, and cost utilization.

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

• Direct provider concerns to internal partners for resolution.

• Address external provider-related issues promptly.

• Investigate, resolve, and communicate about provider claim issues and changes.

• Initiate data entry for changes in provider demographic information.

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

• Conduct provider orientations and continuous education; create and revise orientation materials.

• Manage network performance within the assigned territory.

• Assess provider performance and formulate strategic improvement plans.

• Promote enhancements in Risk/P4Q, HBR, HEDIS/quality, cost, and utilization.

• Complete special projects and other assigned responsibilities.

• Adhere to all policies and standards.

⛳️ Requirements

• Candidates must reside in Florida within Miami Dade County.

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

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

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

• Proficiency in HEDIS/Quality measures, as well as cost and utilization metrics.

• Willingness to travel locally four days a week.

🏝️ Benefits

• Health insurance.

• 401K plan.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

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

• Competitive compensation.

• Additional incentive options may be included in the overall compensation package.