Provider Engagement Account Manager

May 8

🎰 Nevada – Remote

Although this job is listed in Nevada, this company may be open to hiring remote in other states.

💵 $55.1k - $99k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

💰 Account Manager

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Centene Corporation

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Healthcare Insurance • Non-profit • Social Impact

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

10,000+ employees

Founded 1984

⚕️ Healthcare Insurance

🤝 Non-profit

🌍 Social Impact

📋 Description

• 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 plan. • Triages provider 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. • Initiate data entry of provider-related demographic information changes. • 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. • Completes special projects as assigned. • Ability to travel locally 4 days a week. • Performs other duties as assigned. • Complies with all policies and standards.

🎯 Requirements

• 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.

🏖️ Benefits

• competitive pay • health insurance • 401K and stock purchase plans • tuition reimbursement • paid time off plus holidays • flexible approach to work with remote, hybrid, field or office work schedules