Provider Engagement Account Manager

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

📋 Description

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

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

• Engage with providers to identify opportunities for network performance enhancements and solutions

• Oversee consultative account management and ensure accountability for resolving issues

• Propel performance in contract incentive metrics, quality, and cost utilization

• Act as the main point of contact and intermediary between providers and the health plan

• Direct provider issues to relevant internal teams

• Address external provider-related concerns

• Investigate, resolve, and communicate issues related to provider claims and changes

• Input changes to provider-related demographic information

• Educate providers on topics such as referrals, claims submission, website navigation, EDI solicitation, and more

• Conduct provider orientations and provide ongoing education

• Draft and update orientation materials

• Manage network performance within the assigned territory

• Assess provider performance and formulate strategic improvement plans

• Foster advancements in Risk/P4Q, HBR, HEDIS/quality, cost, and utilization

• Execute special projects and other assigned responsibilities

• Adhere to policies and standards

⛳️ Requirements

• Must reside in NJ

• Must have authorization to work in the U.S. without employer-sponsored visa assistance, both currently and in the future

• Bachelor’s degree in a relevant field or equivalent professional experience

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

• Strong proficiency in HEDIS/Quality measures, along with cost and utilization metrics

• Willingness to travel locally four days a week

🏝️ Benefits

• Competitive salary

• Health insurance coverage

• 401K plan

• Stock purchasing options

• Tuition reimbursement opportunities

• Paid time off along with holidays

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

• Additional incentive forms may be included in total compensation

• Commitment to equal opportunity and diversity