Provider Engagement Account Manager — Remote/Hybrid AL

Centene Management Company LLC; Alabama; Hybrid; USD 56,000 - 101,000; Full time

Job summary

Centene Management Company LLC in Alabama is seeking a Provider Relations Specialist to maintain partnerships between the health plan and contracted provider networks, build client relations, and drive performance in quality and cost utilization.

Based in Alabama, the role covers Montgomery, Opp, Andalusia, Troy, and Enterprise; travel locally up to four days a week; you will educate providers, triage issues, manage provider orientations, and contribute to HEDIS/quality initiatives.

Qualifications

• Bachelor’s degree in a 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.
• Proficient in HEDIS/Quality measures, cost and utilization.

Responsibilities

• Maintain partnerships between the health plan and provider networks.
• Engage with providers to improve network performance and cost utilization.
• Triage provider issues and coordinate with internal partners.
• Educate providers on policies, referrals and claims submission.
• Travel locally up to 4 days a week.
• Drive performance on risk, HEDIS/quality metrics.

Skills

Provider relations

Account management

HEDIS/Quality measures

Project management

Data entry

Communication

Cost utilization

Education

Bachelor’s degree or equivalent experience

Tools

EDI systems

CRM software

Microsoft Excel

Job description

Centene Management Company LLC in Alabama is seeking a Provider Relations Specialist to maintain partnerships between the health plan and contracted provider networks, build client relations, and drive performance in quality and cost utilization.

Based in Alabama, the role covers Montgomery, Opp, Andalusia, Troy, and Enterprise; travel locally up to four days a week; you will educate providers, triage issues, manage provider orientations, and contribute to HEDIS/quality initiatives.