Provider Engagement Account Manager [Apply in 3 Minutes] Position Available In Clarke, Georgia

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.

NOTE:

Due to travel requirements, forthis role, we are seeking candidates who live in

Georgia,specifically Fulton, Dekalb or Gwinnett County Position Purpose:

Maintain partnerships between the health plan and the contractedprovider networks serving our communities. Build client relationsto ensure delivery of the highest level of care to our members.

Engage with providers to align on network performance opportunitiesand solutions, and consultative account management andaccountability for issue resolution. Drive optimal performance incontract 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

• Direct Provider Engagement:

  Conductsregular in-person visits with physicians to provide real-timesupport, discuss performance metrics, and identify opportunitiesfor improvement in patient care and clinical practices.

• Value-Based Care Model:

  Focuses on value-based care modelinitiatives, collaborating with physicians to identify and align toperformance-based agreements that incentivize better patientoutcomes, cost-efficiency, and quality care.

•

PerformanceManagement:

Uses data analytics to track and monitor providerperformance, offering actionable feedback to help physiciansoptimize care delivery and meet key performance targets.

Education/Experience:

Bachelor’s degree in related field orequivalent experience. Two years of managed care or medical groupexperience, provider relations, quality improvement, claims,contracting utilization management, or clinical operations. Projectmanagement experience at a medical group, IPA, or health plansetting. Proficient in HEDIS/Quality measures, cost andutilization. Account management experience strongly preferred.

PayRange:

$55,100.00

• $99,000.

00 per year Centene offers acomprehensive benefits package including: competitive pay, healthinsurance, 401K and stock purchase plans, tuition reimbursement,paid time off plus holidays, and a flexible approach to work withremote, hybrid, field or office work schedules. Actual pay will beadjusted based on an individual’s skills, experience, education,and other job-related factors permitted by law. Total compensationmay also include additional forms of incentives. Centene is anequal opportunity employer that is committed to diversity, andvalues the ways in which we are different. All qualified applicantswill receive 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