Title: Provider Engagement Account Manager
Location: Remote
Territory is Bartow County but candidate can live in Cherokee, Pickens, Floyd or Bartow due to field travel required 4 days a week.
Duration: Full-time (Direct Hire)
Must-haves * Valid driver's license

Position Purpose: 
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, and consultative account management and accountability for issue resolution. Drive optimal performance in contract incentive performance, quality, and cost utilization.

• 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 the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc.
• Completes special projects as assigned
• Ability to travel locally 4 days a week
• Performs other duties as assigned
• Complies with all policies and standards
• Direct Provider Engagement: Conducts regular in-person visits with physicians to provide real-time support, discuss performance metrics, and identify opportunities for improvement in patient care and clinical practices.
• Value-Based Care Model: Focuses on value-based care model initiatives, collaborating with physicians to identify and align to performance-based agreements that incentivize better patient outcomes, cost-efficiency, and quality care.
• Performance Management: Uses data analytics to track and monitor provider performance, offering actionable feedback to help physicians optimize care delivery and meet key performance targets.
   

Education/Experience: 

• Bachelor’s degree in related field or equivalent experience.
• Two years of provider engagement account management experience.
• Project management experience at a medical group, IPA, or health plan setting.
• Proficient in HEDIS/Quality measures, cost (MLR) and utilization.

Required Skills:
In person provider engagement experience.
Risk experience (Health Benefit Ratio, emergency room utilization, cost utilization-reducing high cost drivers).

Preferred or Nice-to-have Skills:
HEDIS/Quality Improvement
Value-based care
Claims processing knowledge.

Industry Experience: Managed care | Accountable Care Organization (ACO) or Independent Practice Association (IPA) experience.

***NOTE: For this role, due to travel requirements, we are seeking candidates who live in Georgia, specifically, Bartow, Cherokee, Floyd or Pickens counties***
Is there additional variable compensation? mileage reimbursement 
 
At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $ 75000.00/Yearly.