Health Net
Senior Provider Engagement Account Manager
Health Net, California, Missouri, United States, 65018
Senior Provider Engagement Account Manager
Position Purpose
Develop strategic partnerships between the health plan and the contracted provider networks serving our communities. 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. Participate in the development of network management strategies. Assists in the strategic implementation of new initiatives for performance improvement.
Serve as primary contact for providers and act as a liaison between the providers and the health plan ensuring a coordinated effort in improving financial and quality performance
Triages provider issues as needed and coordinates response with internal matrix partners
Manages Network provider performance for assigned territory through a consultative/account management approach
Evaluates provider performance and develops strategic plan to improve performance to achieve provider and market goals
Assesses prospective providers documentation and assists with closing any gaps in preparation for contracting
Acts as subject matter expert for CalAIM Programs with an emphasis on Doula Providers, housing services, and other Community Supports.
Drives provider performance improvement in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc.
Leveraging data, presents detailed HBR analysis and quality performance; develops reports for Joint Operating Committee meetings (JOC); manages comprehensive action plans to drive performance improvement
Develop proficiency in tools and value based performance (VBP) and educate providers on use of tools and interpretation of data
Coaches new and less experienced Provider Engagement Account Managers
Performs other duties as assigned
Complies with all policies and standards
Direct Provider Engagement: Conducts regular in-person and virtual 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.
Education/Experience 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.
Pay Range $68,700.00 - $123,700.00 per year
Benefits and Equal Opportunity Centene 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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
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
#J-18808-Ljbffr
Develop strategic partnerships between the health plan and the contracted provider networks serving our communities. 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. Participate in the development of network management strategies. Assists in the strategic implementation of new initiatives for performance improvement.
Serve as primary contact for providers and act as a liaison between the providers and the health plan ensuring a coordinated effort in improving financial and quality performance
Triages provider issues as needed and coordinates response with internal matrix partners
Manages Network provider performance for assigned territory through a consultative/account management approach
Evaluates provider performance and develops strategic plan to improve performance to achieve provider and market goals
Assesses prospective providers documentation and assists with closing any gaps in preparation for contracting
Acts as subject matter expert for CalAIM Programs with an emphasis on Doula Providers, housing services, and other Community Supports.
Drives provider performance improvement in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc.
Leveraging data, presents detailed HBR analysis and quality performance; develops reports for Joint Operating Committee meetings (JOC); manages comprehensive action plans to drive performance improvement
Develop proficiency in tools and value based performance (VBP) and educate providers on use of tools and interpretation of data
Coaches new and less experienced Provider Engagement Account Managers
Performs other duties as assigned
Complies with all policies and standards
Direct Provider Engagement: Conducts regular in-person and virtual 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.
Education/Experience 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.
Pay Range $68,700.00 - $123,700.00 per year
Benefits and Equal Opportunity Centene 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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
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
#J-18808-Ljbffr