Provider Engagement Account Manager

Centene Corp.; Arizona; Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K

Stock purchase plan

Tuition reimbursement

PTO + holidays

Flexible schedule

Job summary

Centene Corp. is seeking a Provider Engagement Account Manager to maintain strong partnerships between the health plan and contracted provider networks.

The role emphasizes consultative account management, issue resolution, and driving performance in quality and cost utilization. You will act as the primary contact for providers, educate on policies, and manage network performance across the assigned territory.

Qualifications

• Bachelor’s degree in related field or equivalent experience.
• Experience in managed care, provider relations, or quality improvement.
• Proficient understanding of HEDIS/quality measures and cost/utilization.

Responsibilities

• Maintain partnerships between the health plan and provider networks.
• Serve as primary liaison and triage provider issues with internal teams.
• Educate providers on policies for referrals and claims submission.
• Lead provider orientations and ongoing education materials.
• Evaluate network performance and develop plans to improve outcomes.
• Travel locally up to four days a week as needed.

Skills

Provider relations

Quality improvement

Claims processing

Contracting/utilization management

Clinical operations

Project management

Education

Bachelor’s degree

Job description

## Provider Engagement Account ManagerApply: Remote-AZ: Full time: Posted Yesterday: 1659334**Position Purpose:** Maintain partnerships between the health plan and the contracted provider networks serving our communities. Build client relations to ensure delivery of the highest level of care to our members. 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.**Key Details:** For this role, the candidate must live in Mohave County* 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**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.Pay Range: $56,200.00 - $101,000.00 per year **At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day.** You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.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.