Senior Provider Engagement Account Manager

Role Overview

• Develop strategic partnerships between the health plan and the contracted provider networks serving our communities
• Engage with providers to align on network performance opportunities and solutions, and consultative account management and accountability for issue resolution
• Drive optimal performance in contract incentive performance, quality, and cost utilization
• Participate in the development of network management strategies
• Assist in the strategic implementation of new initiatives for performance improvement
• Serve as primary contact for providers and act as a liaison between the providers and the health plan ensuring a coordinated effort in improving financial and quality performance
• Identify and deliver solutions to providers concerns and issues as needed for resolution to internal partners
• Receive and effectively respond to external provider-related issues
• Investigate, resolve and communicate provider claim issues and changes
• Engage with and educate providers regarding policies and procedures related to referrals and claims submission, website usage, EDI solicitation and related topics
• Perform provider orientations and ongoing provider education, including writing and updating orientation materials
• Manage network performance for assigned territory through a consultative/account management approach
• Evaluate provider performance and develop a strategic plan to improve performance
• Drive provider performance improvement in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc.
• Present detailed HBR analysis and create reports for Joint Operating Committee meetings (JOC)
• Develop proficiency in tools and value-based performance (VBP) and educate providers on the use of tools and interpretation of data
• Coach new and less experienced External Reps
• Ability to travel locally 4 days a week
• Complies with all policies and standards

Requirements

• Bachelor’s degree in related field or equivalent experience
• Three or more years of managed care or medical group experience, provider relations, quality improvement, claims, contracting, utilization management, or clinical operations
• Project management experience at a medical group, IPA, or health plan setting
• Strong communication and presentation skills
• Proficient in HEDIS/Quality measures, cost and utilization.

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