Provider Engagement Account Manager

Centene

Full Time

Mid Level

55k-99k

28 days ago

Job Description

About the Role

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Maintain partnerships between the health plan and the contracted provider networks serving our communities. Build client relations to ensure delivery of the highest level of care to our members. Engage with providers to align on network performance opportunities and solutions, and consultative account management and accountability for issue resolution. Drive optimal performance in contract incentive performance, quality, and cost utilization. Serve as primary contact for providers and act as a liaison between the providers and the health plan.

Key Responsibilities

Triages provider issues as needed for resolution to internal partners.
Receives and effectively responds to external provider related issues.
Investigates, resolves, and communicates provider claim issues and changes.
Initiates data entry of provider-related demographic information changes.
Educates providers regarding policies and procedures related to referrals and claims submission, website usage, EDI solicitation, and related topics.
Performs provider orientations and ongoing provider education, including writing and updating orientation materials.
Manages network performance for assigned territory through a consultative/account management approach.
Evaluates provider performance and develops strategic plans to improve performance.
Drives provider performance improvement in areas such as Risk/P4Q, HBR, HEDIS/quality, cost, and utilization.
Completes special projects as assigned.
Travel locally 4 days a week.
Performs other duties as assigned.
Ensures compliance with all policies and standards.

Requirements

Bachelor's degree in a related field or equivalent experience.
Two years of managed care or medical group experience, provider relations, quality improvement, claims, contracting, utilization management, or clinical operations.
Project management experience at a medical group, IPA, or health plan setting.
Proficient in HEDIS/Quality measures, cost, and utilization.

Nice to Have

Experience with provider network management and performance evaluation.
Knowledge of healthcare policies and procedures.

Qualifications

Educational background as specified in requirements.

Benefits & Perks

Competitive pay
Health insurance
401K and stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible work schedules including remote, hybrid, field, or office work

Working at Centene

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. We are dedicated to helping people live healthier lives through high-quality healthcare, innovative programs, and a wide range of health solutions. We support our employees and provide accommodations as needed to ensure an inclusive work environment.

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