Provider Engagement Account Manager

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

📋 Description

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

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

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

• Deliver consultative account management while ensuring accountability for issue resolution.

• Enhance contract incentive performance, quality, and cost utilization for optimal results.

• Act as the main contact for providers, serving as a liaison between them and the health plan.

• Prioritize and address provider issues in coordination with internal partners.

• Receive and address external provider-related concerns.

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

• Initiate the input of changes to provider-related demographic information.

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

• Conduct provider orientations and ongoing educational sessions.

• Draft and revise orientation materials as needed.

• Oversee network performance in the assigned territory using a consultative/account management strategy.

• Assess provider performance and formulate strategic improvement plans.

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

• Complete special projects and perform other assigned tasks.

• Adhere to all policies and standards.

⛳️ Requirements

• Must reside within 30 miles of Dallas.

• Must have authorization to work in the U.S. without requiring employment-based visa sponsorship now or in the future.

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

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

• Proficient understanding of HEDIS/Quality measures, cost, and utilization.

• Willingness to travel locally four days a week.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase plan.

• Tuition reimbursement assistance.

• Paid time off along with holidays.

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

• Additional incentive options may be included in total compensation.