Provider Engagement Account Manager

15 hours ago

remote us Centene Corporation Full time

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. ***NOTE: For this role we are seeking candidates who live in Oklahoma***Position Purpose: Maintain partnerships between the health plan and the contracted provider networks serving our communities. Build client relations to ensure delivery of the highest level of care to our members. 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.Serve as primary contact for providers and act as a liaison between the providers and the health planTriages provider issues as needed for resolution to internal partnersReceive and effectively respond to external provider related issuesInvestigate, resolve and communicate provider claim issues and changesInitiate data entry of provider-related demographic information changesEducate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topicsPerform provider orientations and ongoing provider education, including writing and updating orientation materialsManages Network performance for assigned territory through a consultative/account management approachEvaluates provider performance and develops strategic plan to improve performanceDrives provider performance improvement in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc.Completes special projects as assignedAbility to travel locally 4 days a weekPerforms other duties as assignedComplies with all policies and standardsDirect Provider Engagement: Conducts regular in-person visits with physicians to provide real-time support, discuss performance metrics, and identify opportunities for improvement in patient care and clinical practices.Value-Based Care Model: Focuses on value-based care model initiatives, collaborating with physicians to identify and align to performance-based agreements that incentivize better patient outcomes, cost-efficiency, and quality care.Performance Management: Uses data analytics to track and monitor provider performance, offering actionable feedback to help physicians optimize care delivery and meet key performance targets. Education/Experience: 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.Project management experience at a medical group, IPA, or health plan setting.Proficient in HEDIS/Quality measures, cost and utilization.Pay Range: $55,100.00 - $99,000.00 per yearCentene 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. 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.

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