Value Based Provider Account Manager Sr. (Medicare)

Anticipated End Date:

2025-05-31

Position Title:

Value Based Provider Account Manager Sr. (Medicare)

Job Description:

Value Based Provider Account Manager Sr. (JR150941)

Location: This role requires associates to be in-office (Atlanta or Columbus/Midland) 1 day per week fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of remote work, promoting a dynamic and adaptable workplace.

To be considered, candidates must reside in the state of Georgia and be willing to visit providers quarterly.

The Value Based Provider Account Manager Sr. is responsible for developing and maintaining positive provider relationships with a portfolio of providers participating in value-based programs in the Commercial, Medicaid, and Medicare lines of business.  

Responsibilities include, but are not limited to:

• Acts as the primary point of contact for providers participating in total cost of care value-based care (VBC) programs.  

• Supports provider engagement, performance, and strategy post contract implementation.

• Advocates for assigned portfolio of strategic providers; fully understanding their operating /business model and proactively identifies opportunities for improved cost and HEDIS-based quality performance.

• Advocates for provider sharing EMR access and/or flat file data sharing.

• Conducts regular on-site and/or virtual/digital visits, communicates administrative and programmatic changes, and facilitates proactive education and the resolution of highly complex issues impacting providers performance in value-based programs.

• Functions as a high-level technical resource in analyzing what is driving provider cost and quality trends to improve provider performance.   

• Leads Joint Operation Committees (JOC), driving the meetings in the discussion of issues and changes.

• Researches and analyzes issues that may impact future VBC program engagement and performance.

• May provide mentorship, training, and guidance to lower-level Value Based Provider Account Mgt. staff.

• This role is not focused on network participation, reimbursement or claims payment inquiries, and/or the resolution of provider data issues.

• Travels 25% of time, meets providers quarterly

Minimum Requirements:

• Bachelor's degree and a minimum of 5 years of customer service experience including 3 years’ experience healthcare or provider environment; or any combination of education and experience, which would provide an equivalent background.

• Travels to worksite and other locations as needed.

Preferred Qualifications:

• Experience working with providers to improve performance in Value-Based programs.

• Experience with Medicare HEDIS strongly preferred; Commercial and Medicaid a plus.

• Experience driving provider performance around cost of care and quality measures.

Job Level:

Non-Management Exempt

Workshift:

1st Shift (United States of America)

Job Family:

PND > Provider Relationship Account Mgmt

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.