Provider Engagement Account Manager
Core
Manage partnerships between a health plan and contracted provider networks to ensure high-quality care delivery and optimal network performance.
Role type
Provider Engagement Account Manager
Builds
Provider network performance and member care delivery
Domain
Healthcare / Managed Care
Deliverable
dashboards & analysis
Required skills
Provider relations, claims management, contract utilization management, quality improvement, project management, HEDIS/Quality measures, cost and utilization analysis
Preferred skills
Knowledge of Kansas HCBS and LTSS waiver programs
Responsibilities
Serve as primary contact for providers and liaison to the health plan; triage and resolve provider issues and claim changes; educate providers on policies, procedures, and EDI; manage network performance and develop strategic improvement plans; drive performance in risk, HBR, HEDIS, cost, and utilization areas.
Seniority
Mid-level, hands-on IC
