Sr. Provider Engagement Account Manager

Centene Corporation; Tampa (FL); Hybrid; USD 68,000 - 124,000; Full time

Job summary

An established industry player is seeking a dedicated individual to enhance partnerships between health plans and providers. This role is pivotal in driving performance improvements, aligning network strategies, and educating providers on essential policies. With a focus on quality and cost utilization, you will engage directly with providers, ensuring optimal outcomes and compliance. This position offers a dynamic work environment with flexible arrangements, allowing you to make a significant impact on community health. If you have experience in managed care and a passion for improving healthcare services, this opportunity is perfect for you.

Benefits

Health Insurance

401K

Tuition Reimbursement

Paid Time Off

Flexible Work Arrangements

Qualifications

• 3+ years in managed care or provider relations.
• Strong communication and presentation skills required.

Responsibilities

• Act as primary contact for providers to improve performance.
• Identify solutions to provider issues and concerns.
• Manage network performance and develop strategic plans.

Skills

Managed Care

Provider Relations

Quality Improvement

Project Management

Communication Skills

Education

Bachelor's Degree

Tools

HEDIS

Job description

Job Description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Candidates must reside in Florida (within one of the covered counties).

This role will cover the following counties in Region 6 & 8: Manatee, Charlotte, Sarasota & DeSoto.

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 provide consultative account management and issue resolution. Drive optimal performance in contract incentives, quality, and cost utilization. Assist in developing network management strategies and implementing new initiatives for performance improvement.

Responsibilities

1. Serve as the primary contact for providers, acting as a liaison between providers and the health plan to improve financial and quality performance.
2. Identify and deliver solutions to provider concerns and issues for resolution with internal partners.
3. Respond effectively to external provider-related issues.
4. Investigate, resolve, and communicate provider claim issues and changes.
5. Engage with and educate providers on policies and procedures related to referrals, claims submission, website usage, EDI, and related topics.
6. Conduct provider orientations and ongoing education, including updating orientation materials.
7. Manage network performance in the assigned territory through a consultative approach.
8. Evaluate provider performance and develop strategic plans for improvement.
9. Drive provider performance in areas such as Risk/P4Q, HBR, HEDIS/quality, cost, and utilization.
10. Present detailed HBR analyses and prepare reports for Joint Operating Committee meetings.
11. Develop proficiency in tools and value-based performance metrics, educating providers on their use and data interpretation.
12. Coach new and less experienced external representatives.
13. Travel locally up to 4 days a week.
14. Perform other duties as assigned and ensure compliance with policies and standards.

Qualifications

• Bachelor’s degree in a related field or equivalent experience.
• At least three years of experience in managed care, provider relations, quality improvement, claims, contracting, utilization management, or clinical operations.
• Project management experience in a medical group, IPA, or health plan setting.
• Strong communication and presentation skills.
• Proficiency in HEDIS/Quality measures, cost, and utilization.
• Valid driver’s license required.

Compensation and Benefits

Pay Range: $68,700.00 - $123,700.00 per year.

Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off and holidays, and flexible work arrangements (remote, hybrid, field, or office schedules). Actual pay will be based on skills, experience, education, and other factors, and total compensation may include additional incentives.

Equal Opportunity Employment

Centene is an equal opportunity employer committed to diversity. All qualified applicants will receive consideration regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics. Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws.