Provider Engagement Account Manager (Northeast PA)

Centene Corporation•Remote-PA, PA

25d•$56,200 - $101,000•Hybrid

About The Position

This person will cover Northeast PA; Lackawana County, Luzerne County, Lycoming County, Monroe County, Columbia County, Schuylkill County, and Northumberland County. The position's purpose is to maintain partnerships between the health plan and the contracted provider networks serving our communities. This role involves building client relations to ensure the delivery of the highest level of care to our members. It also requires engaging with providers to align on network performance opportunities and solutions, providing consultative account management, and accountability for issue resolution. The goal is to drive optimal performance in contract incentive performance, quality, and cost utilization. The role requires the candidate to be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J -1, OPT, or CPT.

Requirements

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J -1, OPT, or CPT
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

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