Provider Engagement Account Manager

Provider Engagement Account Manager

Remote – Georgia (Travel up to 4 days/week within Cobb, Dekalb, Fulton, or Gwinnett County)

Position Type: Full Time

The Provider Engagement Account Manager serves as the key liaison between the health plan and contracted provider networks, ensuring alignment on performance goals and continuous improvement in patient care delivery. This role focuses on provider relationship management, value-based care performance, and cost/utilization optimization. The position requires frequent in-person visits with providers and collaboration with internal teams to improve network quality, outcomes, and efficiency.

Key Responsibilities:

• Serve as the primary contact for network providers, maintaining strong partnerships and acting as liaison with internal teams.
• Conduct regular provider visits to discuss performance metrics, quality measures, and improvement strategies.
• Manage provider performance using data-driven insights to enhance cost efficiency, quality, and patient outcomes.
• Develop and execute strategic performance improvement plans to address risk, P4Q, HEDIS, and Health Benefit Ratio (HBR) metrics.
• Coordinate issue resolution and escalation between providers and health plan departments.
• Support the implementation of value-based care initiatives and provider incentive programs.
• Utilize analytics to monitor contract performance, cost utilization, and quality outcomes.
• Participate in special projects and cross-functional initiatives as assigned.
• Travel locally within the assigned Georgia territory (up to 4 days/week).

Required Qualifications:

• Education: Bachelor's degree in a related field or equivalent experience.
• Experience: Minimum 2 years of provider engagement or account management experience within a managed care organization, IPA, or health plan.
• Demonstrated experience in provider performance management, cost/utilization analysis, and value-based care models.
• Strong understanding of HEDIS/quality measures and medical loss ratio (MLR).
• Excellent communication, negotiation, and relationship management skills.
• Proficiency with Microsoft Office tools and comfort interpreting data and performance reports.
• Willingness and ability to travel up to 4 days/week across Georgia.

Preferred Qualifications:

• Experience in project management within a clinical or provider network environment.
• Background in Population Health, Care Management, or Clinical Operations.
• Experience facilitating performance management conversations with providers.
• Strong problem-solving and analytical thinking abilities.