Provider Engagement Account Manager
About The Position
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. Centene connects people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
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.
- Must live in Mohave County
- Ability to travel locally 4 days a week
Responsibilities
- Serve as primary contact for providers and act as a liaison between the providers and the health plan
- 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
- Performs other duties as assigned
- Complies with all policies and standards
Benefits
- competitive pay
- health insurance
- 401K
- stock purchase plans
- tuition reimbursement
- paid time off
- holidays
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
