Provider Engagement Account Manager - Remote/Hybrid

Centene Corporation; Wichita (KS); 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

Flexible work schedules

Job summary

Centene Corporation seeks a Provider Relations professional to sustain partnerships between the health plan and provider networks in Kansas. You will build client relations to ensure high-quality care for members and align with providers on performance opportunities and solutions.

The role requires a Bachelor's degree and 2+ years in managed care, with travel up to four days weekly. Competitive pay and a robust benefits package accompany this position.

Qualifications

• Bachelor’s degree in related field or equivalent experience.
• Two years of managed care or medical group experience.
• Experience in provider relations, quality improvement, claims, contracting utilization management, or clinical operations.
• Project management experience in a medical group, IPA, or health plan setting.
• Proficient in HEDIS/Quality measures, cost and utilization.
• Strong understanding of Kansas HCBS and LTSS waiver programs.

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.
• Manage Network performance for assigned territory through a consultative/account management approach.
• Evaluate provider performance and develop strategic plan to improve performance.
• Drives provider performance improvement in the areas: Risk/P4Q, Health Benefit Ratio, HEDIS/quality, cost and utilization.
• Completes special projects as assigned.
• Travel locally up to 4 days a week.
• Complies with all policies and standards.

Skills

Provider relations

Account management

Project management

HEDIS/Quality measures

Negotiation

Education

Bachelor’s degree or equivalent experience

Job description

Centene Corporation seeks a Provider Relations professional to sustain partnerships between the health plan and provider networks in Kansas. You will build client relations to ensure high-quality care for members and align with providers on performance opportunities and solutions.

The role requires a Bachelor's degree and 2+ years in managed care, with travel up to four days weekly. Competitive pay and a robust benefits package accompany this position.