Provider Engagement Account Manager

Job not on LinkedIn

🔥 14 hours ago

🌴 South Carolina – Remote

🌴 South Carolina – Remote

💵 $56.2k - $101k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

💰 Account Manager

👻 Ghost score 0%

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

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.

📋 Description

• Maintain partnerships between the health plan and contracted provider networks • Build client relations to support the highest level of care for members • Engage providers to align on network performance opportunities and solutions • Provide consultative account management and accountability for issue resolution • Drive performance in contract incentive performance, quality, and cost utilization • Serve as the primary provider contact and liaison with the health plan • Triage provider issues to internal partners for resolution • Respond to external provider-related issues • Investigate, resolve, and communicate provider claim issues and changes • Enter provider-related demographic information changes • Educate providers on referrals, claims submission, website usage, EDI solicitation, and related topics • Conduct provider orientations and ongoing education • Write and update orientation materials • Manage network performance for an assigned territory • Evaluate provider performance and develop strategic improvement plans • Drive improvements in Risk/P4Q, HBR, HEDIS/quality, cost, and utilization • Complete special projects and other assigned duties • Comply 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 • Home health, SNF or LTSS operations experience strongly preferred • Candidates must live in South Carolina due to travel requirements • Ability to travel locally 4 days a week

🏖️ Benefits

• Health insurance • 401K plan • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation • Equal opportunity employer committed to diversity