Provider Engagement Account Manager

Centene Corporation•Remote-OK, OK

4d•$56,200 - $101,000•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. This position maintains partnerships between the health plan and the contracted provider networks serving our communities. It builds client relations to ensure delivery of the highest level of care to our members. The role engages with Behavioral Health providers to align on network performance opportunities and solutions, and consultative account management and accountability for issue resolution. It drives optimal performance in contract incentive performance, quality, and cost utilization. Note: For this role, we are only considering qualified applicants residing, currently living in Oklahoma. 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.

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.
Ability to travel locally 4 days a week.
Complies with all policies and standards.
Residing, currently living in Oklahoma.
Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.

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.
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.
Uses data analytics to track and monitor provider performance, offering actionable feedback to help physicians optimize care delivery and meet key performance targets.