Provider Engagement Account Manager (Hybrid/Remote)

Centene Corporation; Phoenix (AZ); On-site; USD 56,000 - 101,000; Full time

Benefits offered by this job

Remote/hybrid/field/work options

Job summary

Centene Corporation is seeking a Provider Relations professional to maintain partnerships between the health plan and provider networks serving our communities in Mohave County. The role requires travel up to four days per week and involves education, issue resolution, and performance improvement across contracting, quality, and cost utilization.

The position emphasizes data entry, policy education, and proactive network management to deliver high-quality member care and effective provider

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 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

Skills

Provider relations

Quality improvement

Claims

Contracting utilization management

Clinical operations

Project management

HEDIS/Quality measures

Education

Bachelor's degree or equivalent experience

Job description

Centene Corporation is seeking a Provider Relations professional to maintain partnerships between the health plan and provider networks serving our communities in Mohave County. The role requires travel up to four days per week and involves education, issue resolution, and performance improvement across contracting, quality, and cost utilization.

The position emphasizes data entry, policy education, and proactive network management to deliver high-quality member care and effective provider