Remote Provider Engagement & Performance Manager

Centene Corp.; West Palm Beach (FL); Remote; USD 56,000 - 101,000; Full time

Job summary

Centene Corp. in Florida seeks a Provider Engagement Account Manager to maintain partnerships between the health plan and contracted provider networks. You will serve as the primary contact for providers and drive performance improvements across HEDIS/quality, cost, and utilization.

This remote role requires strong project management, two years of managed care experience, and the ability to travel locally about 4 days a week within the state.

Qualifications

• Two years of managed care or medical group experience, provider relations, quality improvement, claims, contracting utilization management, or clinical operations.
• Project management experience at a medical group, IPA, or health plan setting.
• Proficient in HEDIS/Quality measures, cost and utilization.

Responsibilities

• Maintain partnerships between the health plan and contracted provider networks.
• Serve as primary contact for providers and liaise between providers and the health plan.
• Triage provider issues for resolution with internal partners.
• Investigate, resolve and communicate provider claim issues and changes.
• Educate providers on referrals, claims submission, and related topics.
• Manage network performance for the assigned territory with a consultative approach.
• Evaluate provider performance and develop plans to improve performance.
• Travel locally up to 4 days a week.

Skills

Provider relations

Quality improvement

Claims

Contracting/utilization management

Project management

HEDIS/Quality measures

Education

Bachelor’s degree or equivalent

Job description

Centene Corp. in Florida seeks a Provider Engagement Account Manager to maintain partnerships between the health plan and contracted provider networks. You will serve as the primary contact for providers and drive performance improvements across HEDIS/quality, cost, and utilization.

This remote role requires strong project management, two years of managed care experience, and the ability to travel locally about 4 days a week within the state.