Provider Relationship Account Manager
Core
Manage provider participation changes, regulatory compliance, and network adequacy for a health plan's provider community.
Role type
Senior IC provider relationship and regulatory compliance manager
Builds
Provider network stability, regulatory submissions, and compliance readiness for DMHC/DHCS
Domain
US Healthcare / Managed Care / Regulatory Compliance
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Provider network management, regulatory compliance, audit coordination, stakeholder liaison, policy interpretation, risk mitigation, project planning, data analysis, contract negotiation support, utilization pattern research
Preferred skills
Medicaid experience, regulatory auditing, network certification, GeoAccess analysis, project management, regulatory writing, cross-functional leadership, Microsoft Excel
Technologies
Microsoft Word, Microsoft Excel
Responsibilities
Manage intake and resolution of provider participation changes; Coordinate network adequacy analyses and regulatory submissions; Lead regulatory audits and accreditation reviews; Develop compliance policies and monitoring reports; Serve as liaison with regulators, providers, and internal teams; Conduct proactive outreach and education for providers; Analyze provider utilization patterns impacting service quality.
Seniority
Mid-Senior, hands-on IC