Provider Engagement Account Manager

Centene
Oklahoma
Workplace: RemoteFull timeUSD 56,200 - 101,000 annuallyFunction: Customer Success & Account ManagementEducation: bachelorsSkills: ["Account management","Problem resolution","Data analytics","Communication","Provider education"]

Own provider relationships between the health plan and contracted provider networks for Oklahoma communities. Serve as the primary provider liaison, triage and resolve provider issues, and investigate claim changes. Drive network performance using HEDIS/quality, risk/P4Q, and cost/utilization metrics, developing improvement plans and providing ongoing provider education, including orientations and materials updates.

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FursaFursa
Centene
Centene
1 day ago

Provider Engagement Account Manager

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Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI
Last checked: 11 hours agoStatus: Live
Reposted: similar role first listed 6 months ago

Job Summary

Own provider relationships between the health plan and contracted provider networks for Oklahoma communities. Serve as the primary provider liaison, triage and resolve provider issues, and investigate claim changes. Drive network performance using HEDIS/quality, risk/P4Q, and cost/utilization metrics, developing improvement plans and providing ongoing provider education, including orientations and materials updates.
Location: Oklahoma
Workplace: Remote
Employment Type: Full time
Job Function: Customer Success & Account Management
Seniority: Mid level

Key Responsibilities

  • •Maintain partnerships with contracted provider networks and build client relations to support delivery of high-quality care.
  • •Serve as the primary provider contact and liaison between providers and the health plan; triage provider issues and coordinate internal resolution.
  • •Investigate, resolve, and communicate provider claim issues and changes, including initiating provider-related demographic data entry updates.
  • •Manage network performance for an assigned territory by evaluating provider performance and developing strategic improvement plans across HEDIS/quality, risk/P4Q, HBR, and cost/utilization.
  • •Educate providers on policies and procedures related to referrals and claims submission, web site usage, and EDI solicitation; perform orientations and update orientation materials.
Travel: Extensive travel

Pay and Benefits

Salary: USD 56,200 - 101,000 annually
Equity and Bonus:Equity
Perks:Health Insurance401kEquityPaid LeaveRemote Work

Key Requirements

  • •Bachelor’s degree in a related field or equivalent experience.
  • •Two years of managed care or medical group experience, including provider relations, quality improvement, claims, contracting, utilization management, or clinical operations.
  • •Project management experience in a medical group, IPA, or health plan setting.
  • •Proficiency in HEDIS/quality measures and cost/utilization.
  • •Must be authorized to work in the U.S. without employment-based visa sponsorship now or in the future.
Experience:Managed careMedical groupsHealth plans
Education:Bachelor's
Skills:Account managementProblem resolutionData analyticsCommunicationProvider education
Tech Stack:HEDISEDI

Eligibility

Work Authorization:Authorization required. Sponsorship not provided.

Company Brief

Centene
Centene Corporation is a diversified, multinational healthcare enterprise that provides government-sponsored and commercial healthcare programs and services, specializing in Medicaid, Medicare, and specialty benefits management across the United States.
Industry: Health Insurance (Payers)
Company Size: Enterprise (1,001+ employees)
Revenue: USD 1B+
Growth: Public Company
Valuation: Public Company (Market Cap in USD)
Funding: IPO / Publicly Listed
Headquarters: St. Louis, United States
Founded: 1984
WebsiteLinkedIn