Provider Engagement Account Manager

Centene Corp.; Indiana, Northern (PA, KY); Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Health insurance

401K

Stock purchase plan

Tuition reimbursement

Paid time off

Holidays

Job summary

Centene Corp. is seeking a Provider Engagement Account Manager to maintain partnerships between health plans and provider networks in Indiana. You will act as the primary contact for providers, educate on referrals and claims, and drive network performance with a consultative approach.

Travel up to four days weekly is expected while supporting quality measures. The role requires a related bachelor’s degree and 2+ years in managed care or provider relations, with strong project management skills

Qualifications

• Bachelor’s degree or equivalent experience in a related field.
• 2+ years in managed care, provider relations, quality improvement, or contracting.
• Strong project management and data analysis skills.

Responsibilities

• Serve as primary contact for providers and liaison between providers and the health plan.
• Triages provider issues and coordinates resolution with internal partners.
• Educate providers on referrals, claims submission, and EDI topics.
• Manage network performance in assigned territory with a consultative approach.
• Travel locally up to 4 days a week.

Skills

Provider relations

Account management

Project management

HEDIS/Quality measures

Education

Bachelor's degree in related field

Job description

## Provider Engagement Account ManagerApply: Remote-IN: Full time: Posted Today: 1655833**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**: Candidates must live in Indiana (IN).* 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.