Provider Engagement Account Manager

Centene Corp.; Corpus Christi (TX); Remoto; USD 56.000 - 101.000; Tempo pieno

Descrizione del lavoro

Centene Corp. is seeking a Provider Engagement Account Manager to strengthen partnerships between our health plan and contracted provider networks in the South Texas region.

The role requires frequent travel across Webb, Nueces, Cameron counties and surrounding areas to drive performance, educate providers, and resolve issues efficiently. You'll manage provider relations, influence contract incentives, and monitor quality measures and cost utilization while delivering exceptional care to members

Competenze

• Bachelor's degree in related field or equivalent experience.
• Two years of managed care or provider relations experience.
• Experience with quality measures and utilization management.

Mansioni

• Maintain partnerships between the health plan and contracted provider networks.
• Build client relations to ensure delivery of high-quality care to members.
• Engage with providers to align on network performance opportunities and solutions.
• Provide consultative account management and accountability for issue resolution.
• Drive performance in contract incentives, quality, and cost utilization.
• Travel locally up to 4 days a week across Texas.
• Serve as primary contact for providers and act as liaison between providers and the health plan.
• Triages provider issues for resolution with internal partners.
• Receive and respond to external provider-related issues.
• Investigate, resolve and communicate provider claim issues and changes.
• Data entry of provider-related demographic information changes.
• Educate providers on policies for referrals, claims submission, website usage, and EDI.
• Conduct provider orientations and ongoing provider education.
• Manage network performance for the assigned territory via consultative/account management.
• Evaluate provider performance and develop strategic improvement plans.
• Drive provider performance in Risk/P4Q, HEDIS/quality, cost and utilization.
• Complete special projects as assigned.

Formazione

Bachelor's degree

Two years of managed care experience

Descrizione del lavoro

Provider Engagement Account Manager### Provider Engagement Account ManagerApply: Remote-TX: Corpus Christi - 711 N. Carancahua St., Ste 600 (Superior) (10086): Laredo-Texas(78040): Full time: Posted Yesterday: 1671782**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:** To best support the assigned South Texas territory, candidates should ideally reside in Webb, Nueces, or Cameron County, Texas. The role requires frequent travel throughout the region, including Aransas, Bee, Brooks, Calhoun, Duval, Goliad, Hidalgo, Jim Hogg, Jim Wells, Karnes, Kenedy, Kleberg, Live Oak, Maverick, McMullen, Nueces, Refugio, San Patricio, Starr, Victoria, Willacy, and Zapata counties. * 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.Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act