Bachelor's degree in a related field or equivalent experience
Minimum two years of provider engagement or account management experience
Background in managed care, health plan, IPA, or medical group settings
Proficiency in HEDIS and quality measures, cost (MLR), and utilization management
Requirements:
Build and maintain relationships with providers to support high-quality, cost-effective member care
Serve as the main liaison between providers and the health plan; address and resolve provider-related issues with internal teams
Drive improvements in value-based metrics (Risk/P4Q, HBR, HEDIS, quality, cost, and utilization) using data analytics
Conduct regular in-person meetings with physicians to review performance and opportunities for improvement
Job description
Position Overview: Maintain strong partnerships between the health plan and contracted provider networks. Serve as the primary contact for providers, addressing issues, improving performance, and ensuring quality care delivery.
Location: Georgia (Cobb, Dekalb, Fulton, or Gwinnett County)
Travel: Local travel up to 4 days per week
Key Responsibilities:
Build and maintain relationships with providers to support high-quality, cost-effective member care.
Serve as the main liaison between providers and the health plan.
Address and resolve provider-related issues in collaboration with internal teams.
Evaluate provider performance using data analytics and implement improvement strategies.
Drive enhancements in value-based metrics including Risk/P4Q, HBR, HEDIS, quality, cost, and utilization.
Conduct regular in-person meetings with physicians to review performance metrics and improvement opportunities.
Support provider engagement in value-based care models focused on quality outcomes and cost efficiency.
Manage assigned territory using consultative account management methods.
Complete assigned projects and ensure compliance with all company policies.
Education and Experience:
Bachelor's degree in a related field or equivalent experience.
Minimum two years of provider engagement or account management experience.
Background in managed care, health plan, IPA, or medical group settings.
Proficiency in HEDIS and quality measures, cost (MLR), and utilization management.
Experience in project management and value-based care conversations with providers.
