Provider Engagement Account Manager (Northeast PA)

Summary

Centene connects people to the care they need to live healthier lives through accessible and effective healthcare services. The Provider Engagement Account Manager maintains partnerships with contracted provider networks, manages provider relationships, resolves issues, and drives improvements in quality, cost utilization, and network performance.

Responsibilities

• 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

Skills

• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future
• Ability to travel locally 4 days a week
• 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

Qualifications

Must Haves

• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future
• Ability to travel locally 4 days a week
• 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

Benefits

• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• A flexible approach to work with remote, hybrid, field or office work schedules