Provider Engagement Account Manager (Northwest TX)

Centene Corporation•Remote-TX, TX

2d•$56,200 - $101,000•Hybrid

About The Position

This position is a field-based role covering Northwest Texas, specifically Lubbock and Amarillo Counties. The primary purpose is to maintain partnerships between the health plan and contracted provider networks, ensuring the delivery of high-quality care to members. The role involves building client relations, engaging with providers on network performance, offering consultative account management, and resolving issues. The goal is to drive optimal performance in contract incentives, quality, and cost utilization.

Requirements

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.
Bachelor’s degree in a related field or equivalent experience.
Two years of managed care or medical group experience, provider relations, quality improvement, claims, contracting utilization management, clinical operations, or project management experience at a medical group, IPA, or health plan setting.
Proficient in HEDIS/Quality measures, cost and utilization.

Nice To Haves

Ability to travel locally 4 days a week.

Responsibilities

Serve as the primary contact for providers and act as a liaison between providers and the health plan.
Triage provider issues and resolve them with internal partners.
Receive and respond to external provider-related issues.
Investigate, resolve, and communicate provider claim issues and changes.
Initiate data entry for changes in provider-related demographic information.
Educate providers on policies and procedures related to referrals, claims submission, website usage, EDI solicitation, and other relevant topics.
Perform provider orientations and ongoing provider education, including creating and updating orientation materials.
Manage network performance for the assigned territory through a consultative/account management approach.
Evaluate provider performance and develop strategic plans for improvement.
Drive provider performance improvement in areas such as Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost, and utilization.
Complete special projects as assigned.
Perform other duties as assigned.
Comply with all policies and standards.