Trillium Community Health Plan · 7 hours ago

Provider Engagement Account Manager (Health-Related Social Needs)

United States

Full-time

Remote

Entry, Mid Level

$54K/yr - $97K/yr

2+ years exp

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Responsibilities

Participate in the development of network management strategies for the new HRSN provider network.

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 up to 4 days a week

Performs other duties as assigned

Complies with all policies and standards

Qualification

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Managed Care ExperienceProvider RelationsHEDIS/Quality MeasuresQuality ImprovementClaims ManagementUtilization ManagementClinical OperationsUtilizationProject ManagementData EntryProvider EducationIssue ResolutionClient Relations

Required

Bachelor’s 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.

Candidates must be in Oregon to be considered for this role.

They need to be in the Tri-County/Portland Metro region (Multnomah, Clackamas, or Washington Counties) or the Lane County Region (Lane, Douglas, or Linn Counties).