Provider Relations Account Manager — Remote/Field (NE)

Centene Corporation; Lincoln (NE); 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 (remote,hybrid

Field or office work schedules

Job summary

Centene Corporation is seeking a Provider Relations Specialist for the Nebraska region. This role maintains partnerships between the health plan and contracted provider networks, building client relations to ensure high-quality care for members.

Travel up to four days per week within select Nebraska counties and travel locally as needed. You will triage and resolve provider issues, educate providers on policies, and manage network performance through a consultative approach.

Qualifications

• Bachelor's degree or equivalent experience required.
• Two years of managed care or medical group experience needed.
• Proficient in HEDIS/Quality measures, cost and utilization.

Responsibilities

• Serve as primary contact for providers and act as liaison between providers and the health plan.
• Triages provider issues for resolution with internal partners.
• Respond to external provider related issues and communicate changes.
• Investigate and resolve provider claim issues and changes.
• Enter provider-related demographic changes.
• Educate providers on referrals, claims submission, and EDI topics.
• Provide provider orientations and ongoing education; update materials.
• Manage network performance for the assigned territory via consultative/account management.
• Evaluate provider performance and develop strategies to improve performance.
• Drive provider performance in Risk/P4Q, Quality and Affordability Initiatives, and utilization.

Skills

Provider relations

Account management

Project management

Quality improvement

Education

Bachelor's degree or equivalent experience

Two years managed care experience

Job description

Centene Corporation is seeking a Provider Relations Specialist for the Nebraska region. This role maintains partnerships between the health plan and contracted provider networks, building client relations to ensure high-quality care for members.

Travel up to four days per week within select Nebraska counties and travel locally as needed. You will triage and resolve provider issues, educate providers on policies, and manage network performance through a consultative approach.