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Health Net · 5 hours ago

Provider Engagement Account Manager (State)

California, United States

Full-time

Hybrid

Entry, Mid Level

$26.50/hr - $47.59/hr

2+ years exp

Centene is transforming the health of our communities, one person at a time. The Provider Engagement Account Manager will maintain partnerships between the health plan and the contracted provider networks, ensuring the delivery of high-quality care, and driving optimal performance in contract incentive performance, quality, and cost utilization.

Financial ServicesHealth CareHealth InsuranceInsurancePersonal HealthWellness

Responsibilities

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

Direct Provider Engagement Conducts regular in-person visits with physicians to provide real-time support, discuss performance metrics, and identify opportunities for improvement in patient care and clinical practices

Value-Based Care Model Focuses on value-based care model initiatives, collaborating with physicians to identify and align to performance-based agreements that incentivize better patient outcomes, cost-efficiency, and quality care

Performance Management Uses data analytics to track and monitor provider performance, offering actionable feedback to help physicians optimize care delivery and meet key performance targets

Qualification

Provider relationsData analyticsQuality improvementManaged care experienceProject managementCommunication skillsProblem-solving skillsTeam collaboration

Required

Candidates must reside in California

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