Provider Relationship Account Manager

The Elevance Health Companies, Inc.; Los Angeles (CA); Hybrid; USD 78,000 - 121,000; Full time

Job summary

Elevance Health in California is seeking a Provider Relationship Account Manager to serve as the primary liaison for our provider community.

You will coordinate regulatory compliance, provider participation changes, and network analyses, ensuring continuity of care and adherence to DMHC/DHCS standards while collaborating across regulatory affairs, member services, and operations.

Qualifications

• Requires a bachelor’s degree and 3+ years of customer service experience in healthcare or provider environment.
• Experience with regulatory compliance, audits, and provider networks is preferred.

Responsibilities

• Manage provider participation changes and regulatory compliance activities for designated lines of business.
• Coordinate network adequacy analyses and regulatory submissions to DMHC, DHCS, and other entities.
• Lead regulatory audits, readiness assessments, and related documentation.
• Develop and maintain policies, training materials, and compliance dashboards.
• Collaborate with clinical, quality, care management, health plan, and vendor teams on regulatory initiatives.
• Serve as liaison with regulators, providers, and senior leadership.
• Foster positive provider relationships through on-site and virtual visits and effective issue resolution.

Skills

Customer service

Healthcare experience

Regulatory compliance

Auditing

Provider networks

Cross-functional leadership

MS Word

MS Excel

Education

Bachelor's degree

Tools

MS Word

MS Excel

Job description

Position Title

Provider Relationship Account Manager

Location

This role requires associates to be in-office 1 - 2 days 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 virtual work, promoting a dynamic and adaptable workplace. Ideal candidates will reside within a commuting distance from a California office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Job Description

The Provider Relationship Account Manager will be responsible for providing quality, accessible and comprehensive service to the company's provider community. The Provider Relationship Account Manager oversees provider participation changes and regulatory compliance activities for designated lines of business and delegated entities. This role ensures network changes are evaluated for member impact, continuity of care, network adequacy, operational readiness, and compliance with DMHC, DHCS, and other applicable regulatory and accreditation requirements. The Provider Relationship Account Manager serves as a central point of coordination among Provider Network Management, Regulatory Affairs, Compliance, Case Management, Member Services, Provider Operations, regulators, providers, and other internal and external stakeholders.

How you will make an impact

• Manage the intake, assessment, tracking, escalation, and resolution of provider participation changes.
• Evaluate member and network impacts, including continuity of care, alternative provider access, member communications, and required provider notices.
• Coordinate network adequacy analyses and regulatory submissions required by DMHC, DHCS, and other applicable oversight entities.
• Coordinate responses to regulatory inquiries and ensure supporting documentation is accurate, complete, and submitted within required timeframes.
• Lead regulatory audits, examinations, accreditation reviews, readiness assessments, and related evidence preparation.
• Develop project plans, gap analyses, milestones, risk mitigation strategies, and leadership updates for regulatory initiatives.
• Interpret applicable laws, regulations, contractual requirements, and accreditation standards and provide guidance to business partners.
• Develop and maintain policies, procedures, audit tools, training materials, metrics, dashboards, and compliance monitoring reports.
• Identify regulatory and operational risks, recommend process improvements, and monitor remediation through completion.
• Collaborate with clinical, quality, care management, health plan, growth, and vendor management teams on regulatory and network initiatives.
• Serve as a liaison with regulators, delegated entities, providers, vendors, and senior leadership.
• Develop and maintain positive provider relationships with the provider community by regular on-site and/or virtual/digital visits, communicating administrative and programmatic changes, and facilitating education and the resolution of provider issues.
• Serve as a knowledge and resource expert regarding provider issues impacting provider satisfaction and network retention; research, analyze, and coordinate prompt resolution to complex provider issues and appeals through direct contact with providers and internal matrixed partners.
• Collaborate within a cohort of internal matrix partners to triage issues and submit work requests.
• Be assigned to a portfolio of providers within a defined cohort.
• Coordinate Joint Operation Committees (JOC) of provider groups, driving the meetings in the discussion of issues and changes.
• Assist Annual Provider Satisfaction Surveys, required corrective action plan implementation and monitoring education, contract questions and non-routine claim issues.
• Coordinate communications process on such issues as administrative and medical policy, reimbursement, and provider utilization patterns.
• Conduct proactive outreach to support the understanding of managed care policies and procedures, as well as on a variety of initiatives and programs.
• Participate in external Provider Townhalls/Seminars and attend State Association conferences (e.g.: MGMA, AFP, AAP, HFMA).
• Identify and report on provider utilization patterns which have a direct impact on the quality-of-service delivery.
• Research issues that may impact future provider contract negotiations or jeopardize network retention.

Minimum Requirements

• Requires a bachelor’s degree; minimum of 3 years of customer service experience including 2 years of experience in a healthcare or provider environment; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences

• 2+ years’ experience with regulatory compliance, accreditation, auditing, and provider networks strongly preferred.
• Medicaid experience strongly preferred.
• Experience with provider network changes, regulatory audits, network certification, GeoAccess analysis, continuity of care, or member communications preferred.
• Strong project management, analytical, regulatory writing, and cross-functional leadership skills preferred.
• Proficiency with Microsoft Word and Excel preferred.
• Travels to worksite and other locations as necessary.

For candidates working in person or virtually in the below locations, the salary* range for this specific position is $77,556 to $121,392.

Location(s): California

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans.

Job Level: Non-Management Exempt

Workshift: 1st Shift (United States of America)

Job Family: PND > Provider Relationship Account Mgmt

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.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.

Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration Please visit the Contract Worker Community Page. Elevance Health is an Equal Opportunity Employer/Disability/Veterans.

Join our Talent Community and stay connected with company news, information, and future job opportunities. Fueled by our bold purpose to improve the health of humanity, we are transforming from a traditional health benefits organization into a lifetime trusted health partner.Our nearly 100,000 associates serve approximately 100M+ people, at every stage of health. We address a full range of needs with an integrated whole health approach, powered by industry-leading capabilities and a digital platform for health.