Provider Engagement Account Manager

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

📋 Description

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

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

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

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

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

• Act as the main provider contact and liaison for the health plan.

• Direct provider issues to internal partners for resolution.

• Address external provider-related inquiries.

• Investigate, resolve, and communicate issues and changes regarding provider claims.

• Update provider-related demographic information as necessary.

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

• Conduct provider orientations and facilitate ongoing educational sessions.

• Create and revise orientation materials as needed.

• Oversee network performance for a designated area.

• Assess provider performance and formulate strategic improvement plans.

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

• Complete special projects and other assigned tasks.

• Adhere to all policies and established standards.

⛳️ Requirements

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

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

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

• Strong knowledge of HEDIS/Quality measures, cost, and utilization metrics.

• Experience in home health, SNF, or LTSS operations is highly preferred.

• Candidates must reside in South Carolina due to travel requirements.

• Willingness to travel locally four days a week.

🏝️ Benefits

• Health insurance.

• 401K plan.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off in addition to holidays.

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

• Additional incentives may be included in total compensation.

• Equal opportunity employer committed to diversity.