Provider Engagement Account Manager

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

📋 Description

• Maintain relationships between the health plan and contracted provider networks.

• Foster client relationships to guarantee the highest standards of care for members.

• Collaborate with providers on opportunities for network performance enhancement and solutions.

• Oversee consultative account management and ensure accountability for issue resolution.

• Propel contract incentive performance, quality, and cost utilization.

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

• Direct provider issues to internal partners for resolution.

• Address external provider-related concerns.

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

• Input changes related to provider demographic information.

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

• Conduct provider orientations and ongoing educational sessions for providers.

• Manage network performance within the assigned territory.

• Assess provider performance and create strategic improvement plans.

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

• Complete special projects as designated.

• Perform regular in-person visits to physicians for real-time support and performance evaluations.

• Utilize data analytics to monitor provider performance and offer actionable feedback.

⛳️ Requirements

• Must reside and currently live in Oklahoma.

• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.

• Ability to travel locally four days a week.

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

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

• Project management experience within a medical group, IPA, or health plan environment.

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

🏝️ Benefits

• Competitive pay.

• Health insurance.

• 401K plan.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

• Flexible work arrangements with options for remote, hybrid, field, or office schedules.

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

• Equal opportunity employer committed to diversity.