[High Salary] Provider Engagement Account Manager Position Available In Philadelphia, Pennsylvania

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:

For this role we are seekingcandidates who live in Pennsylvania, specifically

Bucks, Chester,Delaware, Montgomery, or Philadelphia Counties 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

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.

Pay Range:

$55,100.00

• $99,000.

00per year Centene offers a comprehensive benefits package including:competitive pay, health insurance, 401K and stock purchase plans,tuition reimbursement, paid time off plus holidays, and a flexibleapproach to work with remote, hybrid, field or office workschedules. Actual pay will be adjusted based on an individual’sskills, experience, education, and other job-related factorspermitted by law. Total compensation may also include additionalforms of incentives. Centene is an equal opportunity employer thatis committed to diversity, and values the ways in which we aredifferent. All qualified applicants will receive consideration foremployment without regard to race, color, religion, sex, sexualorientation, gender identity, national origin, disability, veteranstatus, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will beconsidered in accordance with the LA County Ordinance and theCalifornia Fair Chance Act