Provider Engagement Account Manager

Centene Corporation; Trenton (NJ); On-site; USD 56,000 - 101,000; Full time

Benefits offered by this job

Health insurance

401K

Stock purchase plan

Tuition reimbursement

Paid time off

Flexible schedules

Job summary

Centene Corporation is seeking a field-based Provider Relations Specialist to reside in New Jersey. You will act as the primary liaison between providers and the health plan, triage issues, educate on policies, and drive performance improvements across risk, HEDIS, and utilization.

You will manage provider relations for a specific territory, handle claims and demographic changes, and collaborate with internal partners to resolve problems. Travel up to four days weekly is required.

Qualifications

• Bachelor’s degree in related field or equivalent experience.
• Two years of managed care or medical group experience.
• Proficient in HEDIS/Quality measures, cost and utilization.

Responsibilities

• Serve as primary contact for providers and liaison between providers and the health plan
• Triages provider issues for resolution to internal partners
• Investigate, resolve and communicate provider claim issues and changes
• Educate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics
• Educate providers and conduct orientations for ongoing education
• Manage network performance for assigned territory through a consultative/account management approach
• Evaluate provider performance and develop a strategic plan to improve performance
• Drives provider performance improvement in risk/P4Q, HBR, quality and utilization
• Complete special projects as assigned
• Ability to travel locally 4 days a week

Skills

Provider relations

Quality improvement

HEDIS knowledge

Data entry

Education

Bachelor’s degree or equivalent

Tools

EDI

Job description

Business Area: Business Development, Sales & Marketing

Job Type: Full time

This position is a field based role requiring the candidate to live in NJ.

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

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 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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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