Provider Engagement Account Manager - Health Related Social Needs
November 16
Description
• Maintain partnerships between the health plan and the contracted provider networks serving our communities • 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 • 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 for the new HRSN provider network • Serve as primary contact for providers and act as a liaison between the providers and the health plan • Triages provider 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 • Initiate data entry of provider-related demographic information 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 areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization
Requirements
• Bachelor’s degree in related field or equivalent experience • Two 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 • Proficient in HEDIS/Quality measures, cost and utilization • Candidates must be in Oregon to be considered for this role
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
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