Provider Relations & Performance Account Manager (Field/Travel)

Centene Corp.; Georgia; Hybrid; 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 arrangements (remote,hyb

Field or office work schedules

Job summary

Centene Corp. in Georgia is seeking a Provider Relations Manager responsible for maintaining partnerships between the health plan and contracted provider networks across multi-county territory.

You will build client relations to ensure delivery of high-quality care and drive performance in incentives, quality, and cost utilization. The role requires a bachelor’s degree and at least two years in managed care or provider relations, with travel four days a week within GA.

Qualifications

• Bachelor’s degree in related field or equivalent experience.
• Two years of managed care or medical group experience in provider relations, quality improvement, claims, contracting utilization management, or clinical operations.
• Proficient in HEDIS/Quality measures; knowledge of Risk Adjustment and value-based care preferred.

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

Account management

HEDIS/Quality measures

Cost and utilization analysis

Risk Adjustment knowledge

VBC knowledge

Education

Bachelor's degree or equivalent experience

Job description

Centene Corp. in Georgia is seeking a Provider Relations Manager responsible for maintaining partnerships between the health plan and contracted provider networks across multi-county territory.

You will build client relations to ensure delivery of high-quality care and drive performance in incentives, quality, and cost utilization. The role requires a bachelor’s degree and at least two years in managed care or provider relations, with travel four days a week within GA.