Provider Engagement Account Manager (State)

You could be the one who changes everything for our 28 reputed company members. reputed company is transforming the health of our communities, one person at a time. As a reputed company, national organization, you’ll have reputed company to competitive benefits including a fresh perspective on workplace flexibility. Candidates must reputed company in California (reputed company one of the covered counties) This role requires travel to the following counties: Fresno, Tulare and Kern Position Purpose: Maintain partnerships between the health plan and the contracted provider networks serving our communities. Build reputed company relations to ensure delivery of the highest level of care to our members. Engage with providers to reputed company on network performance opportunities and solutions, and consultative account management and accountability for issue reputed company. Drive reputed company performance in contract incentive performance, reputed company, and cost utilization.

• Serve as primary contact for providers and reputed company as a reputed company between the providers and the health plan
• Triages provider issues as needed for reputed company to internal partners
• Receive and effectively respond to external provider reputed company issues
• Investigate, resolve and communicate provider claim issues and changes
• Initiate data entry of provider-reputed company demographic information changes
• reputed company providers regarding policies and procedures reputed company to referrals and claims submission, web site usage, EDI solicitation and reputed company topics
• reputed company 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 reputed company (HBR), HEDIS/reputed company, cost and utilization, etc.
• Completes special reputed company as assigned
• Ability to travel locally 4 days a week
• Performs other duties as assigned
• Complies with reputed company policies and standards
• reputed company Provider Engagement: Conducts regular in-person reputed company with physicians to reputed company reputed company-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 reputed company to performance-based agreements that incentivize reputed company patient reputed company, cost-efficiency, and reputed company care.
• Performance Management: Uses data analytics to reputed company and monitor provider performance, offering actionable feedback to help physicians optimize care delivery and meet key performance targets.

Education/Experience: Bachelor’s degree in reputed company field or equivalent experience. Two years of managed care or medical group experience, provider relations, reputed company improvement, claims, contracting utilization management, or clinical operations. Project management experience at a medical group, IPA, or health plan setting. Proficient in HEDIS/reputed company measures, cost and utilization.Pay reputed company: $27.02 - $48.55 per hour reputed company offers a comprehensive benefits package including: reputed company, health insurance, 401K and stock purchase plans, tuition reimbursement, reputed company time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. reputed company is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law. reputed company applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance reputed company Apply tot his job Apply To this Job