Provider Engagement Account Executive
Centene Corporation
full-time
Posted on:
Location Type: Remote
Location: Oregon • United States
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Salary
💰 $87,700 - $157,800 per year
About the role
- Develop strategic partnerships between the health plan and the contracted provider networks serving our communities
- Cultivate client relations and collaborate with providers to ensure delivery of the highest level of care to our members
- Participate in the development of network management strategies
- Creates strategic initiatives for performance improvement
- Serve as a strategic partner/primary contact for hospital systems, multi-specialty groups, and large PCP groups with Value Based/Risk Components
- Executes provider performance improvement strategies in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc
- Builds strong interpersonal relationships with cross functional teams both externally (provider) and internally (health plan)-C-suite Level
- Expert proficiency in tools and value-based performance (VBP) in order to educate providers resulting in improved provider performance
- Resolves provider issues as needed for resolution to internal partners and creating efficiencies to prevent continued concerns
- Receive and effectively respond to external provider related issues
- Investigate, resolve and communicate provider high dollar and high volume provider claim issues and changes
- Educate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics
- Evaluates provider performance and develops strategic plan to improve performance
- Present detailed HBR analysis and create reports for Joint Operating Committee meetings (JOC)
- Acts as a lead for the external representatives
- Coaches and trains external representatives
- Ability to travel locally 4 days a week
- Performs other duties as assigned
- Complies with all policies and standards
Requirements
- Bachelor’s degree in related field or equivalent experience
- Master’s Degree preferred in Public Health (MOH), Health Administration (MHA) or Business Administration (MBA)
- Five or more years of managed care or medical group experience, provider relations, quality improvement, utilization management, or clinical operations
- Project management experience at a medical group, IPA, or health plan setting
- Executive level exposure and ability to influence desired outcomes, innovation, performance, member improvements, growth and Provider retention
- Ability to synthesize complex issues at multiple organizational levels, externally and internally across multi-disciplinary teams
- Highly 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
HEDISquality improvementutilization managementprovider performance improvementrisk managementcost analysisdata analysisproject managementstrategic planningperformance metrics
Soft skills
interpersonal relationshipscollaborationcommunicationcoachingtrainingproblem-solvinginfluencingsynthesis of complex issuesleadershipstrategic thinking
Certifications
Bachelor’s degreeMaster’s Degree in Public Health (MOH)Master’s Degree in Health Administration (MHA)Master’s Degree in Business Administration (MBA)