Provider Engagement Account Manager
About The Position
Maintain partnerships between the health plan and contracted provider networks serving local communities. Build client relations to support the highest level of care for members. Engage providers to align on network performance opportunities and solutions, providing consultative account management and accountability for issue resolution. Drive optimal performance in contract incentives, quality, and cost utilization. The position supports an assigned South Texas territory. Candidates should ideally reside in Webb, Nueces, or Cameron County, Texas. The role requires frequent travel throughout the region, including Aransas, Bee, Brooks, Calhoun, Duval, Goliad, Hidalgo, Jim Hogg, Jim Wells, Karnes, Kenedy, Kleberg, Live Oak, Maverick, McMullen, Nueces, Refugio, San Patricio, Starr, Victoria, Willacy, and Zapata counties. Local travel is required four days a week.
Requirements
- Bachelor’s degree in a related field or equivalent experience.
- Two years of experience in managed care or medical groups, provider relations, quality improvement, claims, contracting, utilization management, or clinical operations.
- Project management experience in a medical group, IPA, or health plan setting.
- Proficiency in HEDIS/quality measures, cost, and utilization.
- Ability to travel locally four days a week.
Nice To Haves
- Residence in Webb, Nueces, or Cameron County, Texas, is ideal.
Responsibilities
- Serve as the primary contact for providers and liaison between providers and the health plan.
- Triage provider issues as needed and route them to internal partners for resolution.
- Receive and effectively respond to external provider-related issues.
- Investigate, resolve, and communicate provider claim issues and changes.
- Initiate data entry of provider-related demographic information changes.
- Educate providers on policies and procedures related to referrals, claims submission, website usage, EDI solicitation, and related topics.
- Conduct provider orientations and ongoing provider education, including writing and updating orientation materials.
- Manage network performance for the assigned territory through a consultative account-management approach.
- Evaluate provider performance and develop strategic plans to improve it.
- Drive provider performance improvement in risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost, and utilization.
- Complete special projects as assigned.
- Perform other duties as assigned.
- Comply with all policies and standards.
Benefits
- Competitive pay
- Health insurance
- 401K
- Stock purchase plans
- Tuition reimbursement
- Paid time off
- Holidays
- Flexible approach to work, with remote, hybrid, field, or office work schedules
- Potential additional forms of incentives
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
