Provider Engagement Account Manager

Centene Corp.; West Palm Beach (FL); Remote; USD 56,000 - 101,000; Full time

Job summary

Centene Corp. in Florida seeks a Provider Engagement Account Manager to maintain partnerships between the health plan and contracted provider networks. You will serve as the primary contact for providers and drive performance improvements across HEDIS/quality, cost, and utilization.

This remote role requires strong project management, two years of managed care experience, and the ability to travel locally about 4 days a week within the state.

Qualifications

• 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.

Responsibilities

• Maintain partnerships between the health plan and contracted provider networks.
• Serve as primary contact for providers and liaise between providers and the health plan.
• Triage provider issues for resolution with internal partners.
• Investigate, resolve and communicate provider claim issues and changes.
• Educate providers on referrals, claims submission, and related topics.
• Manage network performance for the assigned territory with a consultative approach.
• Evaluate provider performance and develop plans to improve performance.
• Travel locally up to 4 days a week.

Skills

Provider relations

Quality improvement

Claims

Contracting/utilization management

Project management

HEDIS/Quality measures

Education

Bachelor’s degree or equivalent

Job description

## Provider Engagement Account ManagerApply: Remote-FL: West Palm Beach-Florida(33411): Full time: Posted Today: 1665857**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**: Candidates must live in Florida within the following counties: Indian River, Martin, Cheechobee, Palm Beach and St. Lucie * 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.Pay Range: $56,200.00 - $101,000.00 per year