Provider Engagement Account Manager

Centene Corporation•Boynton Beach, FL

1d•Hybrid

About The Position

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. Candidates must reside in Florida (within one of the covered counties). This role will cover the following counties in Region G: Indian River, Martin, Cheechobee, Palm Beach and St. Lucie. The purpose of this role is to maintain partnerships between the health plan and the contracted provider networks serving our communities. This involves building client relations to ensure the delivery of the highest level of care to our members. You will engage with providers to align on network performance opportunities and solutions, and provide consultative account management and accountability for issue resolution. This role drives optimal performance in contract incentive performance, quality, and cost utilization. You will serve as the primary contact for providers and act as a liaison between the providers and the health plan.

Requirements

Bachelor’s degree in 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.

Responsibilities

Triages provider issues as needed for resolution to internal partners
Receive and effectively respond to external provider related issues
Investigate, resolve and communicate provider claim issues and changes
Initiate data entry of provider-related demographic information changes
Educate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics
Perform 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 plan to improve performance
Drives provider performance improvement in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc.
Completes special projects as assigned
Ability to travel locally 4 days a week
Performs other duties as assigned
Complies with all policies and standards
Conducts regular in-person visits with physicians to provide real-time support, discuss performance metrics, and identify opportunities for improvement in patient care and clinical practices.
Focuses on value-based care model initiatives, collaborating with physicians to identify and align to performance-based agreements that incentivize better patient outcomes, cost-efficiency, and quality care.
Uses data analytics to track and monitor provider performance, offering actionable feedback to help physicians optimize care delivery and meet key performance targets.