Provider Engagement Account Manager

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

📋 Description

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

• Develop client relationships to guarantee the highest level of care for members.

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

• Deliver consultative account management and take responsibility for resolving issues.

• Promote optimal performance in contract incentives, quality, and cost utilization.

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

• Address provider issues and facilitate resolutions with internal partners.

• Handle external provider-related inquiries and concerns.

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

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

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

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

• Oversee network performance for the assigned territory using a consultative/account management approach.

• Assess provider performance and formulate strategic plans to enhance it.

• Drive improvements in provider performance regarding Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost, and utilization.

• Complete special projects and other assigned responsibilities.

• Adhere to all policies and standards.

⛳️ Requirements

• Candidates must reside in Tennessee (TN).

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

• At least two years of experience in managed care or medical groups, 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 understanding of HEDIS/Quality measures, cost, and utilization.

• Must be able to travel locally four days a week.

🏝️ Benefits

• Health insurance.

• 401K.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

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

• Competitive pay.