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Provider Network Account Manager

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Bright Vision Technologies

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Location:
United States

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Category:
Sales

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Contract Type:
Not provided

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Salary:

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Job Description:

This role is responsible for building and maintaining strong partnerships between the health plan and contracted provider networks. The Provider Engagement Manager serves as the primary liaison between providers and the health plan, driving performance improvement across quality, cost, utilization, and value-based care initiatives.

Job Responsibility:

  • Serve as the primary point of contact for assigned providers
  • Build strong, consultative relationships to ensure high-quality care delivery
  • Conduct regular in-person physician visits to provide real-time support and guidance
  • Perform provider orientations and ongoing education, including updating training materials
  • Triage and resolve provider issues in collaboration with internal teams
  • Investigate, resolve, and communicate provider claims issues
  • Initiate and maintain accurate provider demographic data updates
  • Educate providers on referrals, claims submission, EDI, website tools, and policies
  • Manage network performance using a consultative, data-driven approach
  • Evaluate provider performance and develop improvement strategies
  • Drive performance in key areas including: HEDIS / Quality Measures
  • Drive performance in key areas including: Risk / Pay-for-Quality (P4Q)
  • Drive performance in key areas including: Medical Loss Ratio (MLR) / Health Benefit Ratio (HBR)
  • Drive performance in key areas including: Cost and utilization management
  • Support and align providers with value-based care model initiatives
  • Complete special projects as assigned
  • Travel locally up to 4 days per week
  • Perform other duties as required
  • Ensure compliance with all policies, standards, and regulations

Requirements:

  • Bachelor’s degree in a related field or equivalent experience
  • 2+ years of provider engagement or account management experience
  • Project management experience in a medical group, IPA, or health plan setting
  • Strong working knowledge of: HEDIS / Quality metrics
  • Strong working knowledge of: Cost and utilization management
  • Strong working knowledge of: Value-based care models
What we offer:
  • Competitive base pay
  • Medical, dental, and vision insurance
  • 401(k) and employee stock purchase plans
  • Tuition reimbursement
  • Paid time off and holidays
  • Flexible work arrangements (field, hybrid, or office-based as applicable)

Additional Information:

Job Posted:
January 22, 2026

Employment Type:
Fulltime
Work Type:
On-site work
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