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Provider Engagement Account Manager
Centene Corporation. Maintain partnerships between the health plan and contracted provider networks .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in provider relations, quality improvement, and managed care operations, with a strong focus on HEDIS measures and performance management. Proven ability to build partnerships and drive strategic initiatives to enhance network performance and issue resolution.
Highest-signal resume keywords
Provider Relations ManagementHEDIS/Quality Measures ProficiencyProject Management ExperienceManaged Care ExperienceAccountability for Issue Resolution
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Quality ImprovementClaims ManagementUtilization ManagementContractingDemographic Information ManagementPerformance EvaluationStrategic Improvement PlanningProvider EducationNetwork Performance ManagementConsultative Account Management
Soft Skills
Client RelationsCommunicationProblem SolvingCollaborationEducation and Training
Industry Keywords
Managed CareHealth PlanProvider NetworksRisk/P4QCost UtilizationClinical OperationsIndiana Residency
About the role
Key responsibilities & impact- Maintain partnerships between the health plan and contracted provider networks
- Build client relations to ensure delivery of the highest level of care to members
- Engage providers on network performance opportunities and solutions
- Manage consultative account management and accountability for issue resolution
- Drive performance in contract incentives, quality, and cost utilization
- Serve as primary contact and liaison between providers and the health plan
- Triage provider issues to internal partners for resolution
- Receive and respond to external provider-related issues
- Investigate, resolve, and communicate provider claim issues and changes
- Enter provider-related demographic information changes
- Educate providers on referrals, claims submission, website usage, EDI solicitation, and related topics
- Conduct provider orientations and ongoing provider education
- Write and update orientation materials
- Manage network performance for assigned territory
- Evaluate provider performance and develop strategic improvement plans
- Drive improvement in Risk/P4Q, HBR, HEDIS/quality, cost, and utilization
- Complete special projects and other assigned duties
Requirements
What you’ll need- Candidates must live in Indiana (IN)
- 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
- Ability to travel locally 4 days a week
- Complies with all policies and standards
Benefits
Comp & perks- health insurance
- 401K
- stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work with remote, hybrid, field or office work schedules
- Additional forms of incentives may be included in total compensation