Provider Engagement Account Manager

Centene Corp.; Texas; Hybrid; USD 56,000 - 101,000; Full time

Job summary

Centene Corp. is seeking a Provider Engagement Account Manager to maintain partnerships between the health plan and contracted provider networks, serving as the primary liaison and driving performance improvements.

You will collaborate with providers and internal teams to resolve issues, educate on referrals and claims, and support network performance in a consultative, account-management style. The role requires 2+ years in a related field, a bachelor’s degree, and willingness to travel locally

Qualifications

• 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.
• Proficient in HEDIS/Quality measures, cost and utilization.

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.
• 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 plan to improve performance.
• Drive provider performance improvement in risk, HEDIS/quality, cost and utilization.

Skills

Provider relations

Quality improvement

Account management

HEDIS/Quality measures

Utilization management

Education

Bachelor’s degree in related field

Job description

## Provider Engagement Account ManagerApply: Remote-TX: Full time: Posted Today: 1655884The candidate will ideally reside in Austin or El Paso or surrounding areas. **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:** Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J -1, OPT, or CPT. * 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 or 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