Provider Engagement Account Manager

Provider Engagement Account Manager

Location: Remote (Must reside in Georgia) – Big Canoe, GA 30143 Work Model: Remote + Local Travel (4 days/week) Type: Full-Time

Territory Requirement: Candidates must live in Georgia, specifically in Bartow, Cherokee, Floyd, or Pickens Counties

Core Skills / Keywords: Provider Engagement, Provider Relations, Network Management, Risk, P4Q, HBR, Cost Utilization, ER Utilization, HEDIS, Quality Improvement, Value-Based Care, Managed Care, ACO, IPA, Claims Resolution, Provider Education, Account Management, Territory Management

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. This is a consultative, account management role requiring strong provider-facing experience and the ability 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: Bartow County, Cherokee County, Floyd County, 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