Provider Engagement Account Manager
Centene Corporation
Provider Engagement Account Manager
Centene Corporation
full-time
Posted on:
Origin: • 🇺🇸 United States • New York
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
- 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
- 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
- Uses data analytics to track and monitor provider performance, offering actionable feedback to help physicians optimize care delivery and meet key performance targets
- 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, 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
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
