Provider Engagement Account Manager

Summary

Centene Corporation is a healthcare organization seeking a Provider Engagement Account Manager to maintain partnerships between its health plan and contracted provider networks. The role manages provider relationships, resolves issues, provides education, and drives improvements in network performance, quality, cost, and utilization.

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

• Due to travel requirements,for this role, we are seeking candidates who live in South Carolina
• 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
• Home health, SNF or LTSS operations experience strongly preferred

Qualifications

Must Haves

• Due to travel requirements,for this role, we are seeking candidates who live in South Carolina
• 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

Nice to Haves

• Home health, SNF or LTSS operations experience strongly preferred

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