Provider Engagement Account Manager

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

📋 Description

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

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

• Engage with providers regarding network performance opportunities and solutions.

• Offer consultative account management and take accountability for resolving issues.

• Drive performance in contract incentives, quality metrics, and cost utilization.

• Act as the primary provider contact and liaison with the health plan.

• Direct provider issues to internal teams for effective resolution.

• Address external provider-related concerns promptly.

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

• Update provider demographic information as required.

• Educate providers on referrals, claims submissions, website usage, EDI solicitation, and related subjects.

• Conduct provider orientations and continuous education sessions.

• Create and revise orientation materials as needed.

• Oversee network performance within the assigned territory.

• Assess provider performance and formulate strategic improvement plans.

• Promote enhancements in Risk/P4Q, Health Benefit Ratio, HEDIS/quality, cost, and utilization.

• Complete special projects and additional responsibilities as assigned.

• Adhere to established policies and standards.

⛳️ Requirements

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

• Minimum of two years' experience in managed care or medical group settings, 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 knowledge of HEDIS/Quality measures, cost, and utilization metrics.

• Strong understanding of Kansas HCBS and LTSS waiver programs, including eligibility, service delivery, and regulatory requirements, is preferred.

• Candidates must reside in Kansas City, Kansas.

• Willingness to travel locally four days a week.

🏝️ Benefits

• Competitive compensation.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase plans available.

• Tuition reimbursement assistance.

• Paid time off in addition to holidays.

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

• Additional incentives may be included in the overall compensation package.

• Commitment to equal opportunity and diversity.