Provider Engagement Account Manager

Centene Management Company•Austin, TX

1d•Onsite

About The Position

This field-based position requires the individual to live in Austin. The Provider Engagement Account Manager maintains partnerships between the health plan and contracted provider networks serving the communities, builds client relations to support the highest level of care for members, and engages providers on network performance opportunities and solutions. The role uses consultative account management and accountability for issue resolution to drive performance in contract incentives, quality, and cost utilization. The position serves as the primary contact for providers and liaison between providers and the health plan. It manages network performance for an assigned territory, evaluates provider performance, and develops strategic plans and improvement efforts. The role also supports provider education, issue resolution, provider data changes, and special projects. Local travel is required four days per week. Applicants must be authorized to work in the United States without now or future employment-based visa sponsorship. Sponsorship is unavailable for the listed employment-based visa types.

Requirements

Bachelor’s degree in a related field or equivalent experience.
Two years of experience in managed care or medical groups, 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.
Must be authorized to work in the U.S. without the need for current or future employment-based visa sponsorship.
Must live in Austin.
Ability to travel locally four days a week.

Responsibilities

Serve as the primary provider contact and liaison between providers and the health plan.
Triage provider issues and coordinate resolution with internal partners.
Receive and effectively respond 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 for an assigned territory using 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.