Provider Engagement Account Manager

Job not on LinkedIn

🔥 4 minutes ago

🎸 Tennessee – Remote

🎸 Tennessee – 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 serving communities • Build client relations to ensure delivery of the highest level of care to members • Engage with providers to align on network performance opportunities and solutions • Provide 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 liaison between providers and the health plan • Triage provider issues for resolution to internal partners • 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 on policies and procedures related to referrals, claims submission, website 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 plans to improve performance • Drive provider performance improvement in Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost, and utilization • Complete special projects and other assigned duties • Comply with all policies and standards

🎯 Requirements

• Candidates must live in Tennessee (TN) • 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 • Ability to travel locally 4 days a week

🏖️ Benefits

• Health insurance • 401K • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Competitive pay