Provider Engagement Account Manager

Provider Engagement Account Manager SilverSummit Healthplan We are looking for a provider engagement account manager who will maintain partnerships between the health plan and contracted provider networks serving our communities. You will 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 provide consultative account management and accountability for issue resolution. Drive optimal performance in contract incentive performance, quality, and cost utilization. NOTE: For this role we are seeking candidates who live in Nevada, preferably Las Vegas, Henderson, Summerlin, or North Las Vegas. 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 provide consultative account management and accountability for issue resolution. Drive optimal performance in contract incentive performance, quality, and cost utilization. Responsibilities 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 and Experience Bachelors degree in related field or equivalent experience. Two years of managed care or medical group experience, provider relations, quality improvement, claims, contracting utilization management, or clinical operations. Project management experience at a medical group, IPA, or health plan setting. Proficient in HEDIS/Quality measures, cost and utilization. Pay Range $55,100.00 - $99,000.00 per year Benefits SilverSummit offers a comprehensive benefits package including competitive pay, health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Total compensation may include additional incentives and may be subject to program eligibility. Equal Employment Opportunity SilverSummit is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the Lake County Ordinance and the California Fair Chance Act. Seniority Level Not Applicable Employment Type Full-time Job Function Sales and Business Development #J-18808-Ljbffr