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Senior Provider Engagement Account Manager
Centene Corporation. Develop strategic 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, network performance management, and quality improvement within managed care settings. Proficient in HEDIS measures and capable of delivering consultative account management and strategic partnership development.
Highest-signal resume keywords
Provider RelationsHEDIS/Quality MeasuresManaged Care ExperienceProject ManagementCommunication Skills
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 ImprovementUtilization ManagementClaims ManagementContractingData InterpretationPerformance ImprovementNetwork Management StrategiesRisk/P4QCost UtilizationProvider Performance Evaluation
Soft Skills
Consultative Account ManagementIssue ResolutionCoachingPresentation SkillsEducation and Training
Tools & Technologies
VBP ToolsEDI Solicitation
Industry Keywords
Managed CareMedical GroupProvider NetworksHealth PlanMiami Dade County
About the role
Key responsibilities & impact- Develop strategic partnerships between the health plan and contracted provider networks
- Engage providers to align on network performance opportunities and solutions
- Provide consultative account management and accountability for issue resolution
- Drive performance in contract incentive performance, quality, and cost utilization
- Participate in development of network management strategies
- Implement initiatives for performance improvement
- Serve as primary contact and liaison between providers and the health plan
- Identify and deliver solutions to provider concerns and issues
- Respond to external provider-related issues
- Investigate, resolve, and communicate provider claim issues and changes
- Educate providers on referrals, claims submission, website usage, EDI solicitation, and related topics
- Perform provider orientations and ongoing education; write and update orientation materials
- Manage network performance for assigned territory through consultative account management
- Evaluate provider performance and develop strategic improvement plans
- Drive improvement in Risk/P4Q, HBR, HEDIS/quality, cost, and utilization
- Present HBR analysis and create reports for Joint Operating Committee meetings
- Develop proficiency in VBP tools and educate providers on tool use and data interpretation
- Coach new and less experienced External Representatives
- Perform other assigned duties and comply with policies and standards
Requirements
What you’ll need- Candidates must live in Florida within Miami Dade county
- Bachelor’s degree in related field or equivalent experience
- Three or more 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
- Strong communication and presentation skills
- Proficient in HEDIS/Quality measures, cost and utilization
- Ability to travel locally 4 days a week
Benefits
Comp & perks- Competitive pay
- 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
- Equal opportunity employer committed to diversity