Provider Engagement Account Manager — Field Roles (Nebraska)

Centene Corp.; Omaha (NE); Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work arrangements

Job summary

Centene seeks a Provider Relations professional to maintain partnerships between the health plan and provider networks serving our communities. You will educate providers, triage issues, and drive performance improvements across risk, quality, and cost utilization.

This role requires travel up to four days weekly within Nebraska. Ideal candidates have a related Bachelor’s degree with 2+ years in managed care or provider relations and experience in quality/claims, contracting utilization, or

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.
• Project management experience in medical group, IPA, or health plan setting.
• Proficient in HEDIS/Quality measures, cost and utilization.

Responsibilities

• Serve as primary contact for providers and act as liaison between providers and health plan.
• Triages provider issues for resolution to internal partners.
• Receive and respond to external provider related issues.
• Investigate, resolve and communicate provider claim issues and changes.
• Educate providers regarding policies and procedures related to referrals and claims submission.
• Perform provider orientations and ongoing provider education, including updating orientation materials.

Skills

Provider relations

Project management

Utilization management

Quality improvement

Managed care experience

HEDIS/Quality measures

Education

Bachelor’s degree or equivalent experience

Job description

Centene seeks a Provider Relations professional to maintain partnerships between the health plan and provider networks serving our communities. You will educate providers, triage issues, and drive performance improvements across risk, quality, and cost utilization.

This role requires travel up to four days weekly within Nebraska. Ideal candidates have a related Bachelor’s degree with 2+ years in managed care or provider relations and experience in quality/claims, contracting utilization, or