Provider Engagement Account Lead (Remote GA, Field)

Centene Corp.; Georgia; Remote; USD 56,000 - 101,000; Full time

Benefits offered by this job

Health insurance

401K

Stock purchase plan

Tuition reimbursement

Paid time off

Job summary

Centene Corp. in the United States is seeking a Provider Engagement Account Manager to maintain partnerships with the provider network across a 30-county North Georgia territory.

This remote-based role requires regular travel and acts as the primary liaison between providers and the health plan to drive performance. You will triage issues, educate providers on policies, and shape performance through data-driven strategies in risk adjustment, HEDIS, and cost utilization.

Qualifications

• 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 in a medical group, IPA, or health plan setting. Proficient in HEDIS/Quality measures; knowledge of Risk Adjustment and VBC preferred.

Responsibilities

• Serve as primary contact for providers and act as a liaison between providers and the health plan.
• Triages provider issues as needed for resolution to internal partners.
• Receive and respond to external provider related issues.
• Educate providers regarding policies and procedures related to referrals and claims submission, website usage, EDI, and related topics.
• Perform provider orientations and ongoing provider education, including updating orientation materials.
• Manage Network performance for assigned territory through a consultative/account management approach.
• Evaluate provider performance and develop strategic plan to improve performance.
• Travel locally 4 days a week to cover the 30-county North Georgia territory.

Skills

Managed care

Provider relations

Quality improvement

Claims processing

Utilization management

Contracting

Project management

HEDIS/Quality measures

Risk Adjustment

Value-based care

Education

Bachelor’s degree or equivalent

Job description

Centene Corp. in the United States is seeking a Provider Engagement Account Manager to maintain partnerships with the provider network across a 30-county North Georgia territory.

This remote-based role requires regular travel and acts as the primary liaison between providers and the health plan to drive performance. You will triage issues, educate providers on policies, and shape performance through data-driven strategies in risk adjustment, HEDIS, and cost utilization.