Senior Provider Engagement Account Manager

🔥 14 hours ago

☕ Washington – Remote

☕ Washington – Remote

💵 $70.1k - $126.2k / year

⏰ Full Time

🟠 Senior

💰 Account Manager

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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

• Develop strategic partnerships between the health plan and contracted provider networks • Engage 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 • Participate in development of network management strategies • Assist in strategic implementation of new performance improvement initiatives • Serve as primary contact and liaison between providers and the health plan • Identify and deliver solutions to provider concerns and issues with internal partners • Receive and respond to external provider-related issues • Investigate, resolve, and communicate provider claim issues and changes • Educate providers on referrals, claims submission, website usage, EDI solicitation, and related topics • Perform provider orientations and ongoing provider education • Write and update orientation materials • Manage network performance for assigned territory through consultative/account management • Evaluate provider performance and develop strategic improvement plans • Drive improvement in risk/P4Q, HBR, HEDIS/quality, cost, and utilization • Present HBR analysis and create reports for Joint Operating Committee meetings • Develop proficiency in tools and value-based performance and educate providers on tool use and data interpretation • Coach new and less experienced External Representatives • Perform other duties as assigned • Comply with all policies and standards

🎯 Requirements

• Candidates must live in Washington state (WA) near the supported areas • Bachelor’s degree in related field or equivalent experience • Three or more 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 • Strong communication and presentation skills • Proficient in HEDIS/Quality measures, cost and utilization • Behavioral Health Provider Relations experience preferred • Ability to travel locally 4 days a week

🏖️ Benefits

• Competitive pay • 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

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