Provider Engagement Account Manager

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

📋 Description

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

• Foster client relationships to guarantee the highest level of care delivery to members.

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

• Offer consultative account management and take responsibility for issue resolution.

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

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

• Address provider issues for resolution with internal partners.

• Receive and respond to external provider-related concerns.

• Investigate, resolve, and communicate any provider claim issues and modifications.

• Initiate data entry for changes in provider-related demographic information.

• Educate providers on policies and procedures regarding referrals, claims submission, website usage, EDI solicitation, and related topics.

• Conduct provider orientations and ongoing education, including the creation and updating of orientation materials.

• Manage network performance for the designated territory through a consultative/account management approach.

• Assess provider performance and formulate strategic plans for improvement.

• Drive enhancements in provider performance related to Risk/P4Q, HBR, HEDIS/quality, cost, and utilization.

• Complete special projects as assigned.

• Execute other duties as assigned.

• Adhere to all policies and standards.

⛳️ Requirements

• Candidates must reside in Ohio, preferably within the supported area.

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

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

• Project management experience in a medical group, IPA, or health plan environment is essential.

• Proficiency in HEDIS/Quality measures, cost, and utilization is necessary.

• Willingness to travel locally 4 days a week is required.

🏝️ 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.

• Additional forms of incentives may be included in the total compensation.