Provider Engagement Account Manager

OverviewProvider 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.Location & Work ModelLocation: Remote (Must reside in Georgia) – Big Canoe, GA 30143Work Model: Remote + Local Travel (4 days/week)Territory Requirement: Residents of Georgia, specifically in Bartow, Cherokee, Floyd, or Pickens CountiesMust live in Georgia and be able to travel locally up to 4 days per week.Key ResponsibilitiesServe 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 issuesChanges impacting provider operationsInitiate data entry for provider demographic updates/changes.Educate providers on:Referral policies/proceduresClaims submission processWebsite portal usageEDI solicitation and related workflowsDeliver 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 RequirementsValid Driver's License2+ years of in-person provider engagement / provider account management experienceRisk performance experience, including:Health Benefit Ratio (HBR)ER utilization / utilization managementCost utilization-reducing drivers (high-cost driver reduction)Must live in Georgia – specifically in Bartow County, Cherokee County, Floyd County, or Pickens CountyAbility to travel locally 4 days per weekPreferred / Nice-to-HaveHEDIS / Quality Improvement exposureValue-Based Care experienceClaims processing knowledgeExperience in:Managed CareACO (Accountable Care Organization)IPA (Independent Practice Association)Education / ExperienceBachelor's degree in related field OR equivalent experienceMinimum 2 years provider engagement account management experiencePreferred: Project management experience at a medical group, IPA, or health plan settingPreferred: Working knowledge of HEDIS/Quality, MLR, cost and utilization metricsNote: This description reflects responsibilities and qualifications as provided. Any references to specific templates or submission fields have been removed to ensure clarity and readability.#J-18808-Ljbffr