Provider Engagement Account Manager at Centene

Ideal for a professional with a bachelor’s degree and at least two years of experience in managed care, provider relations, or clinical operations. You need a b

Work type: remote

Location: Remote-MO | Kansas City-Missouri(64118)

Salary: $56,200 – $101,000/yr

Type: Full-time

Summary

Ideal for a professional with a bachelor’s degree and at least two years of experience in managed care, provider relations, or clinical operations. You need a background in project management within a health plan or medical group setting to succeed here. **What makes it worth a look...** Centene offers an annual salary between $56,200 and $101,000 for this role. While listed as a remote position, keep in mind the requirement to travel locally four days a week. **You might be a good fit if you...** * Have hands-on experience navigating HEDIS and quality measures. * Understand the mechanics of cost, utilization, and medical claims. * Can develop strategic plans to improve provider performance. * Manage provider accounts and resolve complex service issues.

Job Description

You could be the one who changes everything for our 28 million members. 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.

Position Purpose: Maintain partnerships between the health plan and the contracted provider networks serving our communities. Build client relations to ensure delivery of the highest level of care to our members. Engage with providers to align on network performance opportunities and solutions, and consultative account management and accountability for issue resolution. Drive optimal performance in contract incentive performance, quality, and cost utilization.

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

Ability to travel locally 4 days a week

Performs other duties as assigned

Complies with all policies and standards

Education/Experience: 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.

Pay Range: $56,200.00 - $101,000.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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