Provider Engagement Account Manager [3 Days Left] Position Available In Duval, Florida

Job Description:

You could be the one who changes everything for our 28 millionmembers. Centene is transforming the health of our communities, oneperson at a time. As a diversified, national organization, you’llhave access to competitive benefits including a fresh perspectiveon workplace flexibility. Candidates must reside in Florida (withinone of the covered counties). This role will cover the followingcounties in Region 4: Clay, Duval, Flagler, Nassau, St. Johns.

Position Purpose:

Maintain partnerships between the health plan andthe contracted provider networks serving our communities. Buildclient relations to ensure delivery of the highest level of care toour members. Engage with providers to align on network performanceopportunities and solutions, and consultative account managementand accountability for issue resolution. Drive optimal performancein contract incentive performance, quality, and cost utilization.

• Serve as primary contact for providers and act as a liaison betweenthe providers and the health plan
• Triages provider issues asneeded for resolution to internal partners
• Receive andeffectively respond to external provider related issues
• Investigate, resolve and communicate provider claim issues andchanges
• Initiate data entry of provider-related demographicinformation changes
• Educate providers regarding policies andprocedures related to referrals and claims submission, web siteusage, EDI solicitation and related topics
• Perform providerorientations and ongoing provider education, including writing andupdating orientation materials
• Manages Network performance forassigned territory through a consultative/account managementapproach
• Evaluates provider performance and develops strategicplan to improve performance
• Drives provider performanceimprovement in the following areas: Risk/P4Q, Health Benefit Ratio(HBR), HEDIS/quality, cost and utilization, etc.
• Completesspecial projects as assigned
• Ability to travel locally 4 days aweek
• Performs other duties as assigned
• Complies with allpolicies and standards

Education/Experience:

Bachelor’s degree inrelated field or equivalent experience. Two years of managed careor medical group experience, provider relations, qualityimprovement, claims, contracting utilization management, orclinical operations. Project management experience at a medicalgroup, IPA, or health plan setting. Proficient in HEDIS/Qualitymeasures, cost and utilization. Drivers License required

Pay Range:

$55,100.00

• $99,000.

00 per year Centene offers a comprehensivebenefits package including: competitive pay, health insurance, 401Kand stock purchase plans, tuition reimbursement, paid time off plusholidays, and a flexible approach to work with remote, hybrid,field or office work schedules. Actual pay will be adjusted basedon an individual’s skills, experience, education, and otherjob-related factors permitted by law. Total compensation may alsoinclude additional forms of incentives. Centene is an equalopportunity employer that is committed to diversity, and values theways in which we are different. All qualified applicants willreceive consideration for employment without regard to race, color,religion, sex, sexual orientation, gender identity, nationalorigin, disability, veteran status, or other characteristicprotected by applicable law. Qualified applicants with arrest orconviction records will be considered in accordance with the LACounty Ordinance and the California Fair Chance Act