Provider Engagement Account Manager

Centene; Reno (NV); Remote; USD 55,000 - 99,000; Full time

Job summary

Join a forward-thinking organization dedicated to transforming healthcare for millions. In this remote role, you'll maintain vital partnerships with healthcare providers, ensuring optimal performance and high-quality care delivery. Your expertise in claims management and provider relations will be crucial in driving improvements in performance metrics. Enjoy a competitive salary and a comprehensive benefits package, including flexible work arrangements. This is an exciting opportunity to make a meaningful impact in the healthcare industry while advancing your career in a supportive environment.

Benefits

Health Insurance

401K

Stock Purchase Plans

Tuition Reimbursement

Paid Time Off

Flexible Work Arrangements

Qualifications

• 2 years of managed care or medical group experience required.
• Proficient in HEDIS/Quality measures, cost, and utilization.

Responsibilities

• Serve as primary contact for providers and manage relationships.
• Investigate and resolve provider claim issues and changes.
• Drive provider performance improvement in various metrics.

Skills

Provider Relations

Claims Management

Quality Improvement

Utilization Management

Project Management

Education

Bachelor’s Degree in a Related Field

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.

***Remote role, candidate must reside in Northern Nevada. Candidate with a strong claims background highly preferred.***

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.

• 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
• Manage network performance for assigned territory through a consultative/account management approach
• Evaluate provider performance and develop strategic plans to improve performance
• Drive provider performance improvement in areas such as Risk/P4Q, HBR, HEDIS/quality, cost, and utilization
• Complete special projects as assigned
• Ability to travel locally 4 days a week
• Perform other duties as assigned
• Comply with all policies and standards

Education/Experience:

Bachelor’s degree in a 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 flexible work arrangements (remote, hybrid, field, or office). Actual pay will be adjusted based on skills, experience, education, and other factors. Total compensation may include additional incentives.

Centene is an equal opportunity employer committed to diversity. All qualified applicants will receive consideration regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics.

Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws.

About the company

Centene Corporation is a publicly traded managed care company based in St.