Provider Engagement Account Manager – Northeast PA

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

📋 Description

• Foster and maintain collaborative partnerships between the health plan and contracted provider networks that serve local communities.

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

• Collaborate with providers to identify performance enhancement opportunities and implement effective solutions.

• Offer consultative account management while ensuring accountability for resolving issues.

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

• Act as the main point of contact for providers and serve as the liaison between providers and the health plan.

• Assess provider concerns and facilitate resolution with internal stakeholders.

• Address and respond to external issues raised by providers.

• Investigate, address, and communicate solutions regarding provider claim issues and changes.

• Initiate the entry of changes related to provider demographic information.

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

• Conduct provider orientations and ongoing educational sessions, including the development and revision of orientation materials.

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

• Assess provider performance and formulate strategic improvement plans.

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

• Complete special projects and fulfill additional assigned responsibilities.

• Adhere to all relevant policies and standards.

⛳️ Requirements

• 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 relevant field or equivalent experience.

• Minimum of two years of experience in managed care or medical group settings, 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 proficiency in HEDIS/Quality measures, cost analysis, and utilization management.

• Willingness to travel locally four days a week.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase plan.

• Tuition reimbursement program.

• Paid time off in addition to holidays.

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

• Additional incentives may be included in the total compensation package.

• Commitment to equal opportunity and diversity.