Provider Engagement Account Manager

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

📋 Description

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

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

• Collaborate with providers on performance opportunities and solutions within the network.

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

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

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

• Address provider issues by coordinating with internal partners for resolution.

• Receive and manage external provider-related inquiries.

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

• Input changes to provider-related demographic information.

• Provide education to providers on referrals, claims submission, website usage, EDI solicitation, and other pertinent topics.

• Conduct provider orientations and continuous educational sessions.

• Draft and revise orientation materials as necessary.

• Manage network performance for the assigned territory.

• Assess provider performance and create strategic plans for improvement.

• Enhance performance in Risk/P4Q, HBR, HEDIS/quality, cost, and utilization.

• Complete special projects and fulfill other assigned responsibilities.

⛳️ Requirements

• Candidates must reside in Indiana (IN).

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

• A minimum of two years in managed care or medical group experience, 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 metrics.

• Ability to travel locally four days a week.

• Adherence to all policies and standards is mandatory.

🏝️ Benefits

• Health insurance.

• 401K.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

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

• Additional forms of incentives may be part of the total compensation package.