Senior Provider Engagement Account Manager at Centene

You are a professional with at least three years of experience in managed care, quality improvement, or provider relations who holds a bachelor’s degree or equi

Work type: remote

Location: Remote-WA State | Renton-Washington(98059) | Seattle-Washington(98133) | Seattle-Washington(98125) | Redmond-Washington(98052) | Seattle-Washington(98118) | Kirkland-Washington(98034) | Bellevue-Washington(98004) | Renton-Washington(98058) | Kent-Washington(98031) | Seattle-Washington(98105) | Kent-Washington(98042) | Seattle-Washington(98122) | Seattle-Washington(98115) | Kent-Washington(98030) | Seattle-Washington(98198) | Kent-Washington(98032) | Kirkland-Washington(98033) | Bellevue-Washington(98006) | Seattle-Washington(98103)

Salary: $70,100 – $126,200/yr

Type: Full-time

Summary

You are a professional with at least three years of experience in managed care, quality improvement, or provider relations who holds a bachelor’s degree or equivalent expertise. You possess direct background in navigating medical group operations, IPA environments, or health plan account management. **What makes it worth a look...** Centene offers a salary range of $70,100 to $126,200 per year for this role based in Washington, specifically for residents living near King County. While the position is remote, it requires local travel four days a week to conduct in-person provider visits and performance consultations. **You might be a good fit if you...** * Have hands-on experience tracking HEDIS and quality measure data. * Know how to interpret cost, utilization, and health benefit ratio reports. * Managed performance initiatives within a value-based care model. * Have a background in project management within a clinical or payer setting.

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.
 

Candidates must reside in Washington (must be in close proximity to King County Washington).​This role will cover King county.Position Purpose:
Develop strategic partnerships between the health plan and the contracted provider networks serving our communities. 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. Participate in the development of network management strategies. Assists in the strategic implementation of new initiatives for performance improvement.

• Serve as primary contact for providers and act as a liaison between the providers and the health plan ensuring a coordinated effort in improving financial and quality performance


• Identify and deliver solutions to providers concerns and 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


• Engage with and 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.


• Present detailed HBR analysis and create reports for Joint Operating Committee meetings (JOC)


• Develop proficiency in tools and value based performance (VBP) and educate providers on use of tools and interpretation of data


• Coaches new and less experienced External Reps


• Ability to travel locally 4 days a week


• Performs other duties as assigned


• Complies with all policies and standards


• Direct Provider Engagement: Conducts regular in-person visits with physicians to provide real-time support, discuss performance metrics, and identify opportunities for improvement in patient care and clinical practices.

• Value-Based Care Model: Focuses on value-based care model initiatives, collaborating with physicians to identify and align to performance-based agreements that incentivize better patient outcomes, cost-efficiency, and quality care.

• Performance Management: Uses data analytics to track and monitor provider performance, offering actionable feedback to help physicians optimize care delivery and meet key performance targets.

Pay Range: $70,100.00 - $126,200.00 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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