RemoteWorker US
Provider Engagement Account Manager
RemoteWorker US, Sun Valley, Nevada, United States, 89433
Join to apply for the
Provider Engagement Account Manager
role at
RemoteWorker US 11 hours ago Be among the first 25 applicants Join to apply for the
Provider Engagement Account Manager
role at
RemoteWorker US You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
Remote role, candidate must reside in Northern Nevada. Candidate with a strong claims background highly preferred.***
Position Purpose:
Maintain partnerships between the health plan and the contracted provider networks serving our communities. Build client relations to ensure delivery of the highest level of care to our members. 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.
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
Education/Experience:
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.Pay Range: $55,100.00 - $99,000.00 per year
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. Total compensation may also include additional forms of incentives.
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
Competitive Salary Employee Perks Welcome Bonus = Sign up today! Seniority level
Seniority level Entry level Employment type
Employment type Full-time Job function
Job function Sales and Business Development Industries Staffing and Recruiting Referrals increase your chances of interviewing at RemoteWorker US by 2x Get notified about new Account Manager jobs in
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Provider Engagement Account Manager
role at
RemoteWorker US 11 hours ago Be among the first 25 applicants Join to apply for the
Provider Engagement Account Manager
role at
RemoteWorker US You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
Remote role, candidate must reside in Northern Nevada. Candidate with a strong claims background highly preferred.***
Position Purpose:
Maintain partnerships between the health plan and the contracted provider networks serving our communities. Build client relations to ensure delivery of the highest level of care to our members. 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.
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
Education/Experience:
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.Pay Range: $55,100.00 - $99,000.00 per year
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. Total compensation may also include additional forms of incentives.
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
Competitive Salary Employee Perks Welcome Bonus = Sign up today! Seniority level
Seniority level Entry level Employment type
Employment type Full-time Job function
Job function Sales and Business Development Industries Staffing and Recruiting Referrals increase your chances of interviewing at RemoteWorker US by 2x Get notified about new Account Manager jobs in
Sun Valley, NV . Sparks, NV $53,417.00-$70,110.00 3 days ago Reno, NV $50,000.00-$90,000.00 4 months ago Reno, NV $70,000.00-$90,000.00 2 weeks ago Sparks, NV $90,000.00-$130,000.00 1 day ago Account Manager - Partnering and OEM Robotics
Reno, NV $50,000.00-$90,000.00 4 months ago Outside Sales Representative (Territory Manager)
Sparks, NV $60,000.00-$85,000.00 1 week ago Experienced Employee Benefits Insurance Account Manager - Reno
Reno, NV $60,000.00-$70,000.00 2 weeks ago Commercial Lines Insurance Account Manager - Reno
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Reno, NV $55,100.00-$99,000.00 11 hours ago Reno, NV $55,100.00-$99,000.00 11 hours ago Personal Lines Insurance Representative - Account Manager
Virginia City, NV $55,100.00-$99,000.00 11 hours ago Reno, NV $75,000.00-$100,000.00 2 weeks ago We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr