Provider Engagement Account Manager

Centene Management Company LLC; Town of Florida (NY); 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

Flexible work options

Job summary

Centene Management Company LLC in Florida is seeking a Provider Relations professional to maintain partnerships with health plan and contracted provider networks, ensuring access to quality care for members.

The role focuses on account management, provider education, resolving provider issues, and improving network performance through HEDIS/quality measures and cost utilization. Local travel up to four days a week is required.

Qualifications

• Bachelor’s degree or related field or equivalent experience.
• Two years of managed care or medical group experience in provider relations or quality.
• Project management experience in medical groups, IPA, or health plans.
• Proficiency with HEDIS/Quality measures, cost and utilization.

Responsibilities

• Serve as primary contact for providers and act as liaison between providers and the health plan.
• Triages provider issues for resolution with internal partners.
• Educate providers on policies, referrals, claims submission, and EDI.
• Manage network performance for assigned territory using a consultative approach.
• Evaluate provider performance and develop plans to improve outcomes.
• Travel locally up to four days per week.

Skills

Provider relations

Account management

Project management

HEDIS/Quality measures

Education

Bachelor’s degree or related field

Two years of managed care or medical group 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 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.

Location

Candidates must live in Florida, preferably in Orange county, around North Osceola or South Seminole. This role will support Orange County providers.

Pay Range

$56,200.00 - $101,000.00 per year

Compensation Details

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

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.

Equal Opportunity

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.

About Centene

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 is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.