Remote Provider Engagement Account Manager

Centene Corp.; Corpus Christi (TX); Remote; USD 56,000 - 101,000; Full time

Job summary

Centene Corp. is seeking a Provider Engagement Account Manager to strengthen partnerships between our health plan and contracted provider networks in the South Texas region.

The role requires frequent travel across Webb, Nueces, Cameron counties and surrounding areas to drive performance, educate providers, and resolve issues efficiently. You'll manage provider relations, influence contract incentives, and monitor quality measures and cost utilization while delivering exceptional care to members

Qualifications

• Bachelor's degree in related field or equivalent experience.
• Two years of managed care or provider relations experience.
• Experience with quality measures and utilization management.

Responsibilities

• Maintain partnerships between the health plan and contracted provider networks.
• Build client relations to ensure delivery of high-quality care to members.
• Engage with providers to align on network performance opportunities and solutions.
• Provide consultative account management and accountability for issue resolution.
• Drive performance in contract incentives, quality, and cost utilization.
• Travel locally up to 4 days a week across Texas.
• Serve as primary contact for providers and act as liaison between providers and the health plan.
• Triages provider issues for resolution with internal partners.
• Receive and respond to external provider-related issues.
• Investigate, resolve and communicate provider claim issues and changes.
• Data entry of provider-related demographic information changes.
• Educate providers on policies for referrals, claims submission, website usage, and EDI.
• Conduct provider orientations and ongoing provider education.
• Manage network performance for the assigned territory via consultative/account management.
• Evaluate provider performance and develop strategic improvement plans.
• Drive provider performance in Risk/P4Q, HEDIS/quality, cost and utilization.
• Complete special projects as assigned.

Education

Bachelor's degree

Two years of managed care experience

Job description

Centene Corp. is seeking a Provider Engagement Account Manager to strengthen partnerships between our health plan and contracted provider networks in the South Texas region.

The role requires frequent travel across Webb, Nueces, Cameron counties and surrounding areas to drive performance, educate providers, and resolve issues efficiently. You'll manage provider relations, influence contract incentives, and monitor quality measures and cost utilization while delivering exceptional care to members