Remote Provider Engagement & Network Performance Manager

Centene Corp.; Texas; Ibrido; USD 56.000 - 101.000; Tempo pieno

Descrizione del lavoro

Centene Corp. is seeking a Provider Engagement Account Manager to maintain partnerships between the health plan and contracted provider networks, serving as the primary liaison and driving performance improvements.

You will collaborate with providers and internal teams to resolve issues, educate on referrals and claims, and support network performance in a consultative, account-management style. The role requires 2+ years in a related field, a bachelor’s degree, and willingness to travel locally

Competenze

• Bachelor’s degree in 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.

Mansioni

• 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.
• 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.
• Drive provider performance improvement in risk, HEDIS/quality, cost and utilization.

Conoscenze

Provider relations

Quality improvement

Account management

HEDIS/Quality measures

Utilization management

Formazione

Bachelor’s degree in related field

Descrizione del lavoro

Centene Corp. is seeking a Provider Engagement Account Manager to maintain partnerships between the health plan and contracted provider networks, serving as the primary liaison and driving performance improvements.

You will collaborate with providers and internal teams to resolve issues, educate on referrals and claims, and support network performance in a consultative, account-management style. The role requires 2+ years in a related field, a bachelor’s degree, and willingness to travel locally