Overview
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.
Location & Work Model Location: Remote (Must reside in Georgia) – Big Canoe, GA 30143
Work Model: Remote + Local Travel (4 days/week)
Territory Requirement: Residents of Georgia, specifically in Bartow, Cherokee, Floyd, or Pickens Counties
Must live in Georgia and be able 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 / P4Q
Health Benefit Ratio (HBR)
Cost and utilization (including high-cost drivers)
Emergency room utilization
HEDIS/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 usage
EDI 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 in Bartow County, Cherokee County, Floyd County, or Pickens County
Ability to travel locally 4 days per week
Preferred / Nice-to-Have
HEDIS / Quality Improvement exposure
Value-Based Care experience
Claims processing knowledge
Experience in:
Managed Care
ACO (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
Note: This description reflects responsibilities and qualifications as provided. Any references to specific templates or submission fields have been removed to ensure clarity and readability.
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Location & Work Model Location: Remote (Must reside in Georgia) – Big Canoe, GA 30143
Work Model: Remote + Local Travel (4 days/week)
Territory Requirement: Residents of Georgia, specifically in Bartow, Cherokee, Floyd, or Pickens Counties
Must live in Georgia and be able 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 / P4Q
Health Benefit Ratio (HBR)
Cost and utilization (including high-cost drivers)
Emergency room utilization
HEDIS/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 usage
EDI 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 in Bartow County, Cherokee County, Floyd County, or Pickens County
Ability to travel locally 4 days per week
Preferred / Nice-to-Have
HEDIS / Quality Improvement exposure
Value-Based Care experience
Claims processing knowledge
Experience in:
Managed Care
ACO (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
Note: This description reflects responsibilities and qualifications as provided. Any references to specific templates or submission fields have been removed to ensure clarity and readability.
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