Provider Engagement Account Manager – State
Centene Corporation
full-time
Posted on:
Location Type: Hybrid
Location: Fresno • California • 🇺🇸 United States
Visit company websiteSalary
💰 $27 - $48 per hour
Job Level
JuniorMid-Level
About the role
- 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
- 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
- Triage 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
- Educate providers regarding policies and procedures related to referrals and claims submission
- Perform provider orientations and ongoing provider education
- Manages Network performance for assigned territory through a consultative/account management approach
- Completes special projects as assigned
- Conducts regular in-person visits with physicians to provide real-time support
- Focuses on value-based care model initiatives
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
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
managed careprovider relationsquality improvementclaims managementcontractingutilization managementclinical operationsproject managementHEDIScost and utilization
Soft skills
client relationscommunicationproblem-solvingeducationconsultative approachliaisonperformance managementrelationship buildingissue resolutionsupport