As a Provider Engagement Account Manager, you will maintain partnerships between the health plan and contracted provider networks, build client relations, and engage with providers to align on network performance opportunities and solutions.
Requirements
- Maintain partnerships between the health plan and contracted provider networks
- Build client relations to ensure delivery of the highest level of care to our members
- Engage with providers to align on network performance opportunities and solutions
- Drive optimal performance in contract incentive performance, quality, and cost utilization
- Serve as primary contact for providers and act as a liaison between the providers and the health plan
- Triage provider issues as needed for resolution to internal partners
- Investigate, resolve and communicate provider claim issues and changes
- Educate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics
- Perform provider orientations and ongoing provider education, including writing and updating orientation materials
- Manages Network performance for assigned territory through a consultative/account management approach
- Evaluates provider performance and develops strategic plan to improve performance
- Drives provider performance improvement in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc.
- Completes special projects as assigned
- Ability to travel locally 4 days a week
- Complies with all policies and standards
- Direct Provider Engagement: Conducts regular in-person visits with physicians to provide real-time support, discuss performance metrics, and identify opportunities for improvement in patient care and clinical practices.
- Value-Based Care Model: Focuses on value-based care model initiatives, collaborating with physicians to identify and align to performance-based agreements that incentivize better patient outcomes, cost-efficiency, and quality care.
- Performance Management: Uses data analytics to track and monitor provider performance, offering actionable feedback to help physicians optimize care delivery and meet key performance targets.
Benefits
- Competitive pay
- Health insurance
- 401K and stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- Flexible approach to work with remote, hybrid, field or office work schedules
