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Provider Engagement Account Manager

L5

veracityDenver, COyesterday

Occupations

Project Management SpecialistsMedical and Health Services ManagersSales Managers

Industries

Direct Health and Medical Insurance CarriersGeneral Medical and Surgical HospitalsAll Other Insurance Related Activities
Provider Engagement Account Manager
Location: Remote (Must reside in Georgia) - Big Canoe, GA 30143
Work Model: Remote + Local Travel (4 days/week)
Type: Full-Time
Territory Requirement: Candidates must live in Georgia, specifically in Bartow, Cherokee, Floyd, or Pickens Counties Core Skills / Keywords: Provider Engagement, Provider Relations, Network Management, Risk, P4Q, HBR, Cost Utilization, ER Utilization, HEDIS, Quality Improvement, Value-Based Care, Managed Care, ACO, IPA, Claims Resolution, Provider Education, Account Management, Territory Management Provider Engagement Account Manager to maintain and strengthen partnerships between the health plan and contracted provider networks serving local communities. This role is responsible for in-person provider engagement, managing provider relationships, resolving provider issues, and driving improvements in quality, risk, and cost/utilization performance across the assigned territory. This is a consultative, account management role requiring strong provider-facing experience and the ability to travel locally up to 4 days per week.
Key Responsibilities:
  • Serve as the primary point of contact for assigned providers and act as liaison between providers and Centene health plan operations.
  • Conduct regular in-person provider visits to support physicians, review performance metrics, and identify improvement opportunities.
  • Manage provider network performance through a consultative/account management approach.
  • Drive provider performance improvements in:
  • Risk / P4QHealth Benefit Ratio (HBR)
  • Cost and utilization (including high-cost drivers)
  • Emergency room utilizationHEDIS/Quality (preferred)
  • Triage provider issues and escalate to internal teams for timely resolution.
  • Investigate, resolve, and communicate:
  • Provider claims issues
  • Changes impacting provider operations
  • Initiate data entry for provider demographic updates/changes.
  • Educate providers on:
  • Referral policies/procedures
  • Claims submission process
  • Website portal usageEDI solicitation and related workflows
  • Deliver provider orientations and ongoing education (including developing/updating orientation materials).Track provider performance using analytics and provide actionable feedback.
  • Complete special projects and other assigned duties.
  • Ensure compliance with all policies and standards.
Must-Have: Requirements Valid Driver's License 2+ years of in-person provider engagement / provider account management experience Risk performance experience, including:
  • Health Benefit Ratio (HBR)ER utilization / utilization management
  • Cost utilization-reducing drivers (high-cost driver reduction)
  • Must live in Georgia - specifically:
  • Bartow County
  • Cherokee CountyFloyd County
  • Pickens County
  • Ability to travel locally 4 days per week
  • Preferred / Nice-to-HaveHEDIS / Quality Improvement exposure
  • Value-Based Care experience
  • Claims processing knowledge
  • Experience in:
  • Managed CareACO (Accountable Care Organization)IPA (Independent Practice Association)
  • Education / Experience
  • Bachelor's degree in related field OR equivalent experience
  • Minimum 2 years provider engagement account management experience
Preferred: Project management experience at a medical group, IPA, or health plan setting
Preferred: Working knowledge of HEDIS/Quality, MLR, cost and utilization metrics
Recruiter Submission Template Full Name: Degree / University & Year of Completion: Total Years of Experience in Healthcare / Managed Care: Provider Engagement / Account Management Experience (Years):Experience in Managed Care or Health Plan Environment (Yes/No - Details):Experience Conducting Direct Provider Engagement (Yes/No - Details):Experience Managing Provider Performance (Cost, Quality, Utilization):Experience with Value-Based Care or Incentive Programs (Yes/No - Details):Experience with HEDIS / Quality Measures (Yes/No - Details):Experience with MLR / Cost Utilization Analysis (Yes/No - Details):Project Management Experience in Healthcare Setting (Yes/No - Details):Experience Using Data Analytics to Monitor Provider Performance (Yes/No - Details):Experience Coordinating Provider Issue Resolution (Yes/No - Details):Comfort Conducting Onsite Provider Visits (Yes/No):Willingness to Travel up to 4 Days/Week within Georgia (Yes/No):Residence Location (City / County - Must be within Cobb, Dekalb, Fulton, or Gwinnett):Proficiency with Microsoft Office and Data Reporting Tools (Yes/No - Specify):Experience Leading Performance Management Conversations with Providers (Yes/No - Details):Motivation / Reason for Interest in this Role: Contact Number: Email ID:LinkedIn Profile URL:Full Address (Street, City, State, ZIP Code):Notice Period (in weeks):Current Work Authorization (U.S. Citizen / Green Card / Visa - Specify):Expected Salary: Are you open to weekly travel across assigned Georgia territory (Travel up to 4 days/week within Cobb, Dekalb, Fulton, or Gwinnett County)? (Yes/No):
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Level

SeniorL5

Location

Denver, CO

Occupation

Project Management Specialists

Industry

Direct Health and Medical Insurance Carriers

Posted

yesterday

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