QA Audit Manager
Datavant
Account Manager, Provider Engagement
Centene Corporation
full-time
Posted on:
Origin: • 🇺🇸 United States • Pennsylvania
Visit company websiteSalary
💰 $55,100 - $99,000 per year
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, and 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 act as a liaison between the providers and the health plan
- Triages 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
- Initiate data entry of provider-related demographic information changes
- Educate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics
- Perform provider orientations and ongoing provider education, including writing and updating orientation materials
- Manages Network performance for assigned territory through a consultative/account management approach
- Evaluates provider performance and develops strategic plan to improve performance
- Drives provider performance improvement in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc.
- Completes special projects as assigned
- Ability to travel locally 4 days a week
- Performs other duties as assigned
- Complies with all policies and standards
- Direct Provider Engagement: Conducts regular in-person visits with physicians to provide real-time support, discuss performance metrics, and identify opportunities for improvement in patient care and clinical practices.
- Value-Based Care Model: Focuses on value-based care model initiatives, collaborating with physicians to identify and align to performance-based agreements that incentivize better patient outcomes, cost-efficiency, and quality care.
- Performance Management: Uses data analytics to track and monitor provider performance, offering actionable feedback to help physicians optimize care delivery and meet key performance targets.
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.
