Provider Engagement Account Manager

Centene Corporation • Corpus Christi, TX

2d • $56,200 - $101,000

About The Position

Maintain partnerships between the health plan and contracted provider networks serving the community, and build client relationships to support the highest level of care for members. Engage providers to identify network performance opportunities and solutions, provide consultative account management, and ensure accountability for issue resolution. Drive performance in contract incentives, quality, and cost utilization.

This role supports an assigned South Texas territory. Candidates should ideally reside in Webb, Nueces, or Cameron County, Texas. Frequent regional travel is required, including travel throughout Aransas, Bee, Brooks, Calhoun, Duval, Goliad, Hidalgo, Jim Hogg, Jim Wells, Karnes, Kenedy, Kleberg, Live Oak, Maverick, McMullen, Nueces, Refugio, San Patricio, Starr, Victoria, Willacy, and Zapata counties. Local travel is required four days a week.

The role requires a bachelor’s degree in a related field or equivalent experience; two years of relevant managed care, medical group, provider relations, quality improvement, claims, contracting, utilization management, or clinical operations experience; project management experience in a medical group, IPA, or health plan setting; and proficiency in HEDIS/quality measures, cost, and utilization.

The listed pay range is $56,200 to $101,000 per year. Centene describes a comprehensive benefits package and a flexible approach to work that may include remote, hybrid, field, or office schedules. Actual pay and benefit eligibility may vary based on individual and program-related factors.

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 travel locally four days a week; frequent travel throughout the assigned South Texas territory is required.

Nice To Haves

• Residence in Webb, Nueces, or Cameron County, Texas, is preferred.

Responsibilities

• Serve as the primary contact for providers and act as a 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 for 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 through 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.
• Travel locally four days a week.
• Perform other duties as assigned.
• Comply with all policies and standards.

Benefits

• Competitive pay
• Health insurance
• 401(k)
• Stock purchase plans
• Tuition reimbursement
• Paid time off
• Holidays
• Flexible approach to work schedules, which may include remote, hybrid, field, or office arrangements

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level