Provider Engagement Account Manager

Provider Engagement Account Manager

07 Sep 2024
North Carolina, Raleigh / durham / CH, 27601 Raleigh / durham / CH USA

Provider Engagement Account Manager

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.Position is based in Greenville, NC area.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.

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: $54,000.00 - $97,100.00 per yearCentene 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. Total compensation may also include additional forms of incentives.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

Related jobs

  • Grade: 5b or 5a (pending candidate experience)

  • Job Title:Account Manager/Relationship Manager (experience level determines role)

  • By clicking the “Apply” button, I understand that my employment application process with Takeda will commence and that the information I provide in my application will be processed in line with Takeda’s Privacy Notice and Terms of Use . I further attest that all information I submit in my employment application is true to the best of my knowledge.

  • Facilities Management- Account Manager: Wilson, NC

  • Allied Universal®, North America’s leading security and facility services company, provides rewarding careers that give you a sense of purpose. While working in a dynamic, diverse and inclusive workplace, you will be part of a team that fuels a culture that will reflect in our communities and customers we serve. We offer medical, dental and vision coverage, life insurance, retirement plan, employee assistance programs, company discounts, perks and more for most full-time positions!

  • Embark on a trailblazing career in Security Technology with Allied Universal® Technology Services, a global leader in security technology that’s transforming the security industry. We integrate state-of-the-art technology with physical security to protect our clients and communities, harnessing tools like electronic access control, video surveillance, and alarm monitoring, alongside emergent innovations such as robotics, drones, and augmented technology. As a valued team member, you’ll be part of a diverse and dynamic workforce that thrives on innovation and inclusivity. We offer a wide spectrum of job opportunities for both stability and growth across various roles, including service and installation technicians, engineers, and project managers. At Allied Universal®, we don’t just embrace change; we drive it, creating a culture where diversity fosters innovation and forges caring connections. Join us and help set new benchmarks in the security industry while advancing your career. Enjoy comprehensive benefits for most full-time positions, including medical, dental, and vision coverage, life insurance, retirement plans, employee assistance programs, and exclusive perks.

  • This position is not approved for sponsorship

Job Details

Jocancy Online Job Portal by jobSearchi.