Provider Engagement Account Manager - Hybrid/Field

Managed Health Services (MHS); Indiana (PA); On-site; USD 56,000 - 101,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Job summary

Centene is seeking a Provider Relations professional to maintain partnerships between the health plan and contracted provider networks, ensuring high-quality member care. You will build client relations, triage issues, educate providers, and drive performance improvements across risk, HEDIS/quality, and cost utilization.

Qualifications include a bachelor’s degree (or equivalent) and 2+ years in managed care or related roles; project management experience is a plus.

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 at a 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 a liaison between providers and the health plan.
• Triages provider issues as needed 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, 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.
• Travel locally 4 days a week.

Skills

Provider relations

Quality improvement

Contract utilization management

Project management

Education

Bachelor’s degree or equivalent experience

Job description

Centene is seeking a Provider Relations professional to maintain partnerships between the health plan and contracted provider networks, ensuring high-quality member care. You will build client relations, triage issues, educate providers, and drive performance improvements across risk, HEDIS/quality, and cost utilization.

Qualifications include a bachelor’s degree (or equivalent) and 2+ years in managed care or related roles; project management experience is a plus.