Provider Relationship Account Manager

Elevance Health

. Manage the intake, assessment, tracking, escalation, and resolution of provider participation changes .

Posted 9/18/2026full-timeWoodland Hills • California • United StatesMid-LevelSenior💰 $77,556 - $121,392 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in regulatory compliance, provider network management, and project management within the healthcare sector. Proficient in analyzing and interpreting laws, regulations, and accreditation standards while effectively collaborating with various stakeholders.

Highest-signal resume keywords

Regulatory ComplianceProvider Network ManagementProject ManagementAnalytical SkillsRegulatory Writing

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Regulatory AuditingGeoAccess AnalysisContinuity Of CareAccreditation StandardsProvider Network ChangesCustomer ServiceHealthcare Environment ExperienceData AnalysisRisk Mitigation StrategiesPolicy Development

Soft Skills

Cross-Functional LeadershipCommunicationProblem SolvingCollaborationRelationship Management

Tools & Technologies

Microsoft WordMicrosoft Excel

Industry Keywords

MedicaidProvider ParticipationNetwork AdequacyRegulatory InquiriesCompliance MonitoringProvider Utilization PatternsAccreditation ReviewsProvider Satisfaction SurveysManaged Care PoliciesHealthcare Regulations

About the role

Key responsibilities & 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 oversight entities
Coordinate responses to regulatory inquiries and ensure accurate, complete, timely supporting documentation
Lead regulatory audits, examinations, accreditation reviews, readiness assessments, and evidence preparation
Develop project plans, gap analyses, milestones, risk mitigation strategies, and leadership updates for regulatory initiatives
Interpret laws, regulations, contractual requirements, and accreditation standards and advise 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
Collaborate with clinical, quality, care management, health plan, growth, and vendor management teams
Liaise with regulators, delegated entities, providers, vendors, and senior leadership
Maintain provider relationships through on-site and virtual visits, communications, education, and issue resolution
Research, analyze, and coordinate resolution of complex provider issues and appeals
Triage issues and submit work requests with internal matrix partners
Manage an assigned portfolio of providers within a defined cohort
Coordinate Joint Operation Committees of provider groups
Assist with annual provider satisfaction surveys, corrective action plans, education monitoring, contract questions, and non-routine claims issues
Coordinate communications regarding administrative and medical policy, reimbursement, and provider utilization patterns
Conduct proactive outreach on managed care policies, procedures, initiatives, and programs
Participate in provider town halls, seminars, and state association conferences
Identify and report provider utilization patterns affecting quality of service
Research issues affecting future provider contract negotiations or network retention

Requirements

What you’ll need

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 providing an equivalent background
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
Ability to travel to the worksite and other locations as necessary
Must reside within commuting distance of a California office
Ability to work in-office 1–2 days per week
Certain patient/member-facing roles require COVID-19 and Influenza vaccination unless an acceptable explanation is provided

Benefits

Comp & perks

Comprehensive benefits package
Incentive and recognition programs
Equity stock purchase
401(k) contribution and match
Merit increases
Paid holidays
Paid Time Off
Incentive bonus programs
Medical, dental, and vision benefits
Short- and long-term disability benefits
Stock purchase plan
Life insurance
Wellness programs
Financial education resources
Hybrid work flexibility
Professional and personal growth opportunities