Provider Engagement Account Manager

Tennessee Health Plan; Jackson (TN); On-site; USD 56,000 - 101,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work arrangements (remote,hyb

Job summary

Centene seeks a Provider Relations Manager to maintain partnerships with contracted networks and drive performance across risk, quality, and cost utilization. You will educate providers, manage provider issues, and lead strategic plans to improve HEDIS/quality measures while coordinating with internal teams.

Travel in Tennessee is required; remote options may apply. Responsibilities include serving as primary contact for providers, triaging issues, educating on referrals and claims, and driving

Qualifications

• Bachelor’s degree in related field or equivalent experience.
• Two years of managed care or medical group experience in provider relations or quality improvement.
• Project management experience in a medical group, IPA, or health plan setting.
• Proficient in HEDIS/Quality measures, cost and utilization.

Responsibilities

• Serve as primary contact for providers and liaise between providers and the health plan.
• Triages provider issues for resolution with internal partners.
• Educate providers on policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics.
• 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 Risk/P4Q, HBR, HEDIS/quality, cost and utilization.
• Completes special projects as assigned.
• Ability to travel locally 4 days a week.
• Complies with all policies and standards.

Skills

Provider relations

Quality improvement

Utilization management

Project management

HEDIS/Quality measures

Data analysis

Education

Bachelor’s degree in related field or equivalent experience

Job description

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 Tennessee (TN). This role will support the upper half of West Tennessee.

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

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

Pay Range: $56,200.00 - $101,000.00 per year

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.

Benefits

• competitive pay
• 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

Company Culture

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.

Equal Opportunity Statement

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.