Provider Engagement Account Manager

2 weeks ago

Concord, New Hampshire, United States WellCare of North Carolina Full time

Job Summary

We are seeking a skilled Provider Engagement Account Manager to join our team at WellCare of North Carolina. As a key member of our organization, you will be responsible for maintaining partnerships between our health plan and contracted provider networks. Your primary goal will be to build strong client relations, ensuring the delivery of high-quality care to our members.

Key Responsibilities

  • Act as the primary contact for providers and serve as a liaison between them and our health plan.
  • Triage provider issues and resolve them in collaboration with internal partners.
  • Receive and respond to external provider-related issues effectively.
  • Investigate, resolve, and communicate provider claim issues and changes.
  • Initiate data entry of provider-related demographic information changes.
  • Educate providers on policies and procedures related to referrals, claims submission, website usage, EDI solicitation, and other topics.
  • Perform provider orientations and ongoing education, including writing and updating orientation materials.
  • Manage network performance for assigned territories through a consultative/account management approach.
  • Evaluate provider performance and develop strategic plans to improve it.
  • Drive provider performance improvement in areas such as risk, quality, cost, and utilization.
  • Complete special projects as assigned.
  • Ability to travel locally 4 days a week.
  • Perform other duties as assigned.
  • Comply with all policies and standards.

Requirements

We are looking for a candidate with a Bachelor's degree in a 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 are required. Project management experience in a medical group, IPA, or health plan setting is also desirable. Proficiency in HEDIS/Quality measures, cost, and utilization is essential.

What We Offer

We offer a comprehensive benefits package, including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid 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-related factors permitted by law. Total compensation may also include additional forms of incentives.

Equal Opportunity Employer

We are an equal opportunity employer committed to diversity and value 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.

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