Provider Engagement Account Manager

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

📋 Description

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

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

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

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

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

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

• Address provider issues for resolution in collaboration with internal partners.

• Handle external provider-related issues effectively.

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

• Input changes to provider-related demographic information.

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

• Conduct provider orientations and ongoing educational sessions.

• Draft and update orientation materials as needed.

• Oversee network performance within the assigned territory.

• Assess provider performance and create strategic improvement plans.

• Drive enhancements in provider performance in areas such as Risk/P4Q, HBR, HEDIS/quality, cost, and utilization.

• Complete special projects and other assigned responsibilities.

• Adhere to all policies and standards.

⛳️ Requirements

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

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

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

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

• Willingness to travel locally four days a week.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase plans available.

• Tuition reimbursement offered.

• Paid time off in addition to holidays.

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

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