Provider Engagement Account Manager/Behavioral Health at Centene

Ideal candidates have at least two years of experience in managed care, provider relations, or clinical operations and hold a bachelor’s degree. You are an expe

Work type: remote

Location: Jackson - 111 E Capitol St., Ste 500 (Magnolia) (10106) | Remote-MS

Salary: $56,200 – $101,000/yr

Type: Full-time

Summary

Ideal candidates have at least two years of experience in managed care, provider relations, or clinical operations and hold a bachelor’s degree. You are an expert at navigating medical group dynamics and interpreting complex claims data to support behavioral health providers. **What makes it worth a look...** Centene offers a salary between $56,200 and $101,000 per year. While this role is remote, you must live in specific Mississippi counties or nearby Louisiana parishes to handle local travel 2 to 4 days a week. **You might be a good fit if you...** * Have specific experience working with behavioral health providers or psychiatric services. * Are proficient in HEDIS quality measures and utilization management. * Can analyze billing workflows and claims processing documentation. * Understand credentialing requirements and health information exchange protocols.

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.

NOTE: Because this role involves travel across the Mississippi Gulf Coast region, we’re looking for candidates who live in Mississippi (Hinds, Jackson, or Rankin counties) or in nearby Louisiana parishes, including East or West Feliciana, East Baton Rouge, St. Helena, Tangipahoa, or Washington ParishPosition Purpose: Maintain and strengthen partnerships between the health plan and the contracted Behavioral Health provider networks serving our communities. Serve as a strategic consultative liaison ensuring delivery of the highest level of care to our members. Engage with providers to align network performance opportunities and solutions, and consultative account management and accountability for issue resolution. Drive optimal performance incentive performance, quality, and cost utilization.

Serve as primary contact for providers and act as a liaison between the providers and the health plan

Receive and effectively respond to external provider related issues

Completes special projects as assigned

Ability to travel locally 2-4 days a week

Complies with all policies and standards

Conducts regular in-person and virtual visits with Behavioral Health physicians to provide real-time support for Claims, Credentialing, and Care Management, UM, Network, and Compliance

Educate providers regarding policies and procedures related to referrals, claims submission, credential documentation, self-service tools, websites, Electronic Health Records, Health Information Exchange, and Electronic Data Interface

Investigate, document, and drive resolution of Behavioral Health provider concerns, ensuring timely follow-up and clear communication

Receive, triage, and resolve provider-related issues in coordination with internal partners including claims, credentialing, care management, utilization management, network, and compliance

Build and sustain collaborative, solution-oriented partnerships that enhance provider satisfaction and network stability

Ensure effective escalation and tracking of issues through closure.

Translate complex claims and utilization data into clear, actionable insight for providers and internal stakeholders

Partner with analytics, finance, and operations teams to ensure data accuracy and alignment

Perform other duties as assigned

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.

The following experience is strongly preferred:Direct experience working with Behavioral Health providers (psychiatry, therapy, substance use, crisis services, etc.) strongly preferred. Minimum of two (2) years of provider engagement or account management experience, preferably within Behavioral Health in a health plan, IPA, medical group, or similar healthcare setting. Hands-on experience supporting provider operations, including claims processing and analysis, billing workflows, credentialing, and provider office management. Demonstrated ability to analyze and interpret claims and utilize data to identify trends, resolve provider issues, and support performance improvement discussions. Experience collaborating cross-functionally with Claims, Network, Credentialing, Care Management, and Compliance teams to drive issue resolution and performance outcomes.

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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