PROLIM www.prolim.com is currently seeking Provider Engagement Account Manager for one of our top Client for Location - Remote - Territory is Bartow County, GA, but candidate can live in Cherokee, Pickens, Floyd, or Bartow due to field travel required 4 days a week.
Qualified candidates can directly send their updated resume and contact information via email: jayaprakash.hiremath@prolim.com
Job Description:
NOTE: For this role due to travel requirements, we are seeking candidates who live in Georgia, specifically Bartow, Cherokee, Floyd, or Pickens counties.
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 consultative account management and accountability for issue resolution. Drive optimal performance in contract incentive performance quality and cost utilization.
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 plans to improve performance. Drives provider performance improvement in the following areas: Risk, P4Q, Health Benefit Ratio, HBR, HEDIS, quality, cost, and utilization. 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, Experience, and Skills
Education:
Experience:
Skills:
Years of Experience
Industry Experience
Education Requirements
About PROLIM
PROLIM is a leading provider of PLM IoT and Digital transformation solutions to Global Fortune 1000 companies. With 9 global offices in the US, India, and Australia, PROLIM has won 30 awards and proudly serving over 1200 customers to innovate and improve their profitability and efficiency. PROLIM was founded in 2005 and is headquartered in Farmington Hills, USA. With the global footprint and expertise in the latest technologies, PROLIM can partner with you to speed up your Digital Transformation journey.