Louisiana Healthcare Connections
Provider Engagement Account Manager
Louisiana Healthcare Connections, Louisiana, Missouri, United States, 63353
Provider Relations Account Manager
Location: Orleans Parish, Louisiana
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.
Responsibilities
Serve as primary contact for providers and act as a liaison between the providers and the health plan
Triage 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
Manage network performance for assigned territory through a consultative/account management approach
Evaluate provider performance and develop a strategic plan to improve performance
Drive provider performance improvement in areas Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc.
Complete special projects as assigned
Travel locally 4 days a week
Perform other duties as assigned
Comply with all policies and standards
Direct provider engagement: conduct 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 focus: collaborate with physicians to identify and align to performance‑based agreements that incentivize better patient outcomes, cost‑efficiency, and quality care.
Performance Management: use 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.
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.
Compensation Pay Range: $55,100.00 - $99,000.00 per year
Benefits Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K, stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.
Equal Opportunity Employer 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.
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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.
Responsibilities
Serve as primary contact for providers and act as a liaison between the providers and the health plan
Triage 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
Manage network performance for assigned territory through a consultative/account management approach
Evaluate provider performance and develop a strategic plan to improve performance
Drive provider performance improvement in areas Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc.
Complete special projects as assigned
Travel locally 4 days a week
Perform other duties as assigned
Comply with all policies and standards
Direct provider engagement: conduct 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 focus: collaborate with physicians to identify and align to performance‑based agreements that incentivize better patient outcomes, cost‑efficiency, and quality care.
Performance Management: use 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.
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.
Compensation Pay Range: $55,100.00 - $99,000.00 per year
Benefits Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K, stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.
Equal Opportunity Employer 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.
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