Provider Engagement Account Manager

Cenetene Corporation; Newark (NJ); Hybrid; USD 55,000 - 99,000; Full time

Job summary

An established industry player is seeking a dedicated professional to enhance provider relations and network performance. In this pivotal role, you will serve as the primary liaison between health plans and providers, ensuring optimal care delivery for millions of members. Your expertise in managed care and project management will drive improvements in quality and cost utilization, while your ability to educate and engage with providers will foster strong partnerships. This role offers a dynamic work environment with flexible scheduling options, making it an exciting opportunity for those passionate about making a difference in healthcare.

Benefits

Health Insurance

401K Plan

Tuition Reimbursement

Paid Time Off

Flexible Work Schedules

Qualifications

• Bachelor's degree or equivalent experience required.
• Two years in managed care or provider relations preferred.

Responsibilities

• Maintain partnerships with providers and ensure high-quality care delivery.
• Drive performance improvement in provider networks through strategic planning.
• Educate providers on policies and claims submission.

Skills

Provider Relations

Project Management

Quality Improvement

Claims Management

Cost Utilization Analysis

Education

Bachelor's Degree in Related Field

Tools

HEDIS

Job description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

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.

1. Serve as primary contact for providers and act as a liaison between the providers and the health plan
2. Triages provider issues as needed for resolution to internal partners
3. Receive and effectively respond to external provider related issues
4. Investigate, resolve and communicate provider claim issues and changes
5. Initiate data entry of provider-related demographic information changes
6. Educate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics
7. Perform provider orientations and ongoing provider education, including writing and updating orientation materials
8. Manages Network performance for assigned territory through a consultative/account management approach
9. Evaluates provider performance and develops strategic plan to improve performance
10. Drives provider performance improvement in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc.
11. Completes special projects as assigned
12. Ability to travel locally 4 days a week
13. Performs other duties as assigned
14. 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:

$55,100.00 - $99,000.00 per year

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. Total compensation may also include additional forms of incentives.

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.