Provider Engagement Account Manager

Centene Corporation • Phoenix, AZ • 1h ago

Position Purpose: 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.

Key Details: For this role, the candidate must live in Mohave County

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

Education/Experience: 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.Pay Range: $56,200.00 - $101,000.00 per year

At Centene, we connect people to the care they need to live healthier lives - and the work you do here makes that impact real every day. You'll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It's work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

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 flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Go to Apply

CUSTOMER SERVICE RESPRESENTATIVE 2

State of Arizona • Phoenix, AZ • 4h ago

Management & Administrative

Job No: 543820 Work Type: Full-time Location: REMOTE OPTIONS,PHOENIX Categories: Administrative Support/Customer Service BARBERING AND COSMETOLOGY BOARD To protect the public's health and safety by licensing qualified sc...

4h ago

Go to Apply

Management Solution Architect - Proposal Strategy & Content Development (Remote)

GovCIO • Phoenix, AZ • 4h ago

Management & Administrative

United States No Clearance Needed Fully remote Information Technology Overview GovCIO is seeking an experienced growth leader to serve as a Management Solution Architect who will focus on developing and refining manageme...

4h ago

Go to Apply

Consultant Incubator (COIN) Analyst

Cognizant • Phoenix, AZ • 8h ago

Management & Administrative

About Cognizant Consulting Cognizant Consulting is more than Cognizant's consulting practice, we're a global community of 5,000+ experts dedicated to helping clients reimagine their business. Blending our deep industry a...

8h ago

Go to Apply

Administrative Support Clerk

Banner Health • Chandler, AZ • 9h ago

Management & Administrative

Primary City/State: Chandler, Arizona Department Name: Accounts Payable-Corp Work Shift: Day Job Category: Administrative Services Schedule: In-Office Monday - Friday 7:00 - 3:30pm Find your path in health care. We want...

9h ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)