Senior Provider Engagement Account Manager

December 21, 2024

🇺🇸 United States – Remote

🏄 California – Remote

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

💵 $67.4k - $121.3k / year

⏰ Full Time

🟠 Senior

💰 Account Manager

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Centene Corporation

WebsiteLinkedInAll Job Openings

Contracting • Network Development • Managed Care

10,000+ employees

Founded 1984

⚕️ Healthcare Insurance

🤝 Non-profit

🌍 Social Impact

Description

• Develop strategic partnerships between the health plan and contracted provider networks • Engage with providers to align on network performance opportunities and solutions • Consultative account management and accountability for issue resolution • Drive optimal performance in contract incentive performance, quality, and cost utilization • Participate in the development of network management strategies • Assist in the strategic implementation of new initiatives for performance improvement • Serve as primary contact for providers and act as a liaison between providers and health plan • Identify and deliver solutions to providers concerns and issues • Receive and effectively respond to external provider related issues • Investigate, resolve and communicate provider claim issues and changes • Educate providers regarding policies and procedures related to referrals and claims submission • Perform provider orientations and ongoing provider education • Manage Network performance for assigned territory through consultative/account management approach • Evaluate provider performance and develop strategic plan to improve performance • Present detailed HBR analysis and create reports for Joint Operating Committee meetings (JOC)

Requirements

• 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

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