Provider Engagement Account Manager

Centene Corporation•Remote-GA, GA

2d•$56,200 - $101,000

About The Position

Maintain partnerships between the health plan and contracted provider networks serving local communities. Build client relationships to support high-quality care for members, and engage providers to identify network performance opportunities and solutions. Provide consultative account management, ensure accountability for issue resolution, and drive performance in contract incentives, quality, and cost utilization. The role supports an assigned multi-county territory in Georgia and requires regular local travel four days a week. Residence in or near Coweta, Spalding, Butts, or Jasper County is preferred for travel accessibility. Candidates elsewhere within reasonable proximity may be considered if they can meet the travel requirements.

Requirements

Bachelor’s degree in a related field or equivalent experience.
Two years of experience in managed care or a medical group, provider relations, quality improvement, claims, contracting, utilization management, or clinical operations.
Project management experience in a medical group, IPA, or health plan setting.
Proficiency in HEDIS/quality measures, cost, and utilization.
Ability to meet local travel requirements four days a week.

Nice To Haves

Knowledge of Risk Adjustment and value-based care (VBC) is strongly preferred.
Residence in or near Coweta, Spalding, Butts, or Jasper County is preferred; candidates elsewhere within reasonable proximity may be considered based on ability to meet travel requirements.

Responsibilities

Serve as the primary contact for providers and liaison between providers and the health plan.
Triage provider issues and coordinate resolution with internal partners.
Receive and respond effectively to external provider-related issues.
Investigate, resolve, and communicate provider claim issues and changes.
Initiate data entry of provider demographic information changes.
Educate providers on policies and procedures related to referrals, claims submission, website usage, EDI solicitation, and related topics.
Conduct provider orientations and ongoing provider education, including writing and updating orientation materials.
Manage network performance in the assigned territory using a consultative account-management approach.
Evaluate provider performance and develop strategic plans to improve it.
Drive provider performance improvement in Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost, and utilization.
Complete special projects as assigned.
Perform other duties as assigned.
Comply with all policies and standards.
Travel locally four days a week.