Senior Provider Engagement Account Manager

Centene Management Company LLC; Florida; Hybrid; USD 70,000 - 126,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Job summary

Centene Florida (Miami area) seeks a Provider Relations professional to develop strategic partnerships between the health plan and contracted networks serving our communities.

You will serve as primary contact for providers, drive performance in quality, cost utilization, and HEDIS, and manage an advisory approach across the territory. Candidates should have a bachelor’s degree and 3+ years of managed care or provider relations experience; travel up to four days weekly is required.

Qualifications

• 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.

Responsibilities

• Serve as primary contact for providers and liaise between the providers and the health plan to improve financial and quality performance.
• Identify and deliver solutions to provider concerns and issues as needed for resolution to internal partners.
• Receive and 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.
• 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/P4Q, HBR, HEDIS/quality, cost and utilization.

Skills

Communication skills

Presentation skills

Project management

HEDIS/Quality measures

Cost & utilization analysis

Education

Bachelor’s degree in related field or equivalent experience

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.

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.

Key Details

Candidates must live in Florida within Miami Dade county. This role will support Miami and surrounding areas.

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

Pay Range: $70,100.00 - $126,200.00 per year.

Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Benefits

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.

Equal Opportunity

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.

Company Culture

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.