Provider Engagement Account Manager

Centene Management Company • Omaha, NE

2d

About The Position

Maintain partnerships between the health plan and contracted provider networks serving local communities. Build client relationships to support the highest level of care for members, align providers with network performance opportunities and solutions, and provide consultative account management and accountability for issue resolution. Drive performance in contract incentives, quality, and cost utilization. This position requires local travel up to four days per week. Candidates should live in Nebraska, specifically Dodge, Douglas, Cass, Sarpy, or Washington County.

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.
• Ability to travel locally four days per week.
• Candidates should live in Nebraska in Dodge, Douglas, Cass, Sarpy, or Washington County.

Responsibilities

• Serve as the primary contact for providers and liaison between providers and the health plan.
• Triage provider issues and coordinate resolution with internal partners.
• Receive and respond effectively to external provider-related issues.
• Investigate, resolve, and communicate provider claim issues and changes.
• Initiate data entry of 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 education, including writing and updating orientation materials.
• Manage network performance for the 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, Quality and Affordability Initiatives (QAI), HEDIS/quality, cost, and utilization.
• Complete special projects as assigned.
• Travel locally four days per week.
• Perform other duties as assigned.
• Comply with all policies and standards.

Benefits

• Competitive pay
• Health insurance
• 401(k) and stock purchase plans
• Tuition reimbursement
• Paid time off and holidays
• Flexible approach to work, with remote, hybrid, field, or office work schedules

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level