Senior Provider Engagement Account Manager

Centene Corp.; Miami, Northern (FL, KY); Hybrid; USD 70,000 - 126,000; Full time

Job summary

Centene Corp. in Miami, FL seeks a Provider Relations Manager to develop strategic partnerships between the health plan and contracted provider networks. You will serve as the primary contact for providers, align on performance opportunities, and drive improvements in cost, quality, and utilization.

The role requires 3+ years in managed care or provider relations, a Bachelor's degree, strong communication and presentation skills, and willingness to travel locally up to 4 days a week.

Qualifications

• Bachelor’s degree or equivalent experience.
• Three or more years of managed care or medical group experience, provider relations, quality improvement, claims, contracting, utilization management, or clinical operations.
• Project management experience in medical group, IPA, or health plan setting.
• Strong communication and presentation skills.
• Proficient in HEDIS/Quality measures, cost and utilization.

Responsibilities

• Serve as primary contact for providers and act as a liaison between the providers and the health plan ensuring a coordinated effort in improving financial and quality performance.
• Identify and deliver solutions to providers concerns and 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.
• Engage with and 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.
• Present detailed HBR analysis and create reports for Joint Operating Committee meetings (JOC).
• Develop proficiency in tools and value based performance (VBP) and educate providers on use of tools and interpretation of data.
• Coaches new and less experienced External Reps.
• Ability to travel locally 4 days a week
• Performs other duties as assigned
• Complies with all policies and standards

Skills

Communication skills

Presentation skills

Project management

Education

Bachelor’s degree or equivalent experience

3+ years of managed care or medical group experience

Tools

HEDIS/Quality measures

Cost and utilization analysis

Job description

**Position Purpose:** Develop strategic partnerships between the health plan and the contracted provider networks serving our communities. Engage with providers to align on network performance opportunities and solutions, and consultative account management and accountability for issue resolution. Drive optimal performance in contract incentive performance, quality, and cost utilization. Participate in the development of network management strategies. Assists in the strategic implementation of new initiatives for performance improvement.**Key details**: Candidates must live in Florida within Miami Dade county. This role will support Miami and surrounding areas.* Serve as primary contact for providers and act as a liaison between the providers and the health plan ensuring a coordinated effort in improving financial and quality performance* Identify and deliver solutions to providers concerns and 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* Engage with and 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.* Present detailed HBR analysis and create reports for Joint Operating Committee meetings (JOC)* Develop proficiency in tools and value based performance (VBP) and educate providers on use of tools and interpretation of data* Coaches new and less experienced External Reps* Ability to travel locally 4 days a week* Performs other duties as assigned* Complies with all policies and standards**Education/Experience:** Bachelor’s degree in related field or equivalent experience. Three or more 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. Strong communication and presentation skills Proficient in HEDIS/Quality measures, cost and utilization.Pay Range: $70,100.00 - $126,200.00 per year