Peach State Health Plan
Provider Engagement Account Manager
Peach State Health Plan, Augusta, Georgia, United States, 30910
Overview
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Provider Engagement Account Manager
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Peach State Health Plan Centene is transforming the health of our communities, one person at a time. This role supports partnerships between the health plan and contracted provider networks, with a focus on network performance, quality, and cost utilization. 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 with 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 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 Manage Network performance for assigned territory through a consultative/account management approach Evaluate provider performance and develop strategic plans to improve performance Drive provider performance improvement in areas such as Risk/P4Q, HBR, HEDIS/quality, cost and utilization Complete special projects as assigned Travel locally up to 4 days a week Perform other duties as assigned and comply 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: focus on initiatives, collaborating with physicians to identify and align to performance-based agreements Performance Management: uses data analytics to track provider performance and offer actionable feedback to optimize care delivery and meet KPIs 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 in a medical group, IPA, or health plan setting. Proficient in HEDIS/Quality measures, cost and utilization. Compensation and Benefits
Pay Range:
$55,100.00 - $99,000.00 per year Centene offers a comprehensive benefits package including health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and flexible work arrangements (remote, hybrid, field, or office). Actual pay will be adjusted based on skills, experience, education, and status. Total compensation may include incentives. Benefits may be subject to program eligibility. Equal Opportunity
Centene is an equal opportunity employer committed to diversity. 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 protected characteristic. Qualified applicants with arrest or conviction records will be considered in accordance with applicable law. Seniority level
Not Applicable Employment type
Full-time Job function
Sales and Business Development Industries
Hospitals and Health Care Insurance
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Join to apply for the
Provider Engagement Account Manager
role at
Peach State Health Plan Centene is transforming the health of our communities, one person at a time. This role supports partnerships between the health plan and contracted provider networks, with a focus on network performance, quality, and cost utilization. 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 with 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 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 Manage Network performance for assigned territory through a consultative/account management approach Evaluate provider performance and develop strategic plans to improve performance Drive provider performance improvement in areas such as Risk/P4Q, HBR, HEDIS/quality, cost and utilization Complete special projects as assigned Travel locally up to 4 days a week Perform other duties as assigned and comply 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: focus on initiatives, collaborating with physicians to identify and align to performance-based agreements Performance Management: uses data analytics to track provider performance and offer actionable feedback to optimize care delivery and meet KPIs 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 in a medical group, IPA, or health plan setting. Proficient in HEDIS/Quality measures, cost and utilization. Compensation and Benefits
Pay Range:
$55,100.00 - $99,000.00 per year Centene offers a comprehensive benefits package including health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and flexible work arrangements (remote, hybrid, field, or office). Actual pay will be adjusted based on skills, experience, education, and status. Total compensation may include incentives. Benefits may be subject to program eligibility. Equal Opportunity
Centene is an equal opportunity employer committed to diversity. 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 protected characteristic. Qualified applicants with arrest or conviction records will be considered in accordance with applicable law. Seniority level
Not Applicable Employment type
Full-time Job function
Sales and Business Development Industries
Hospitals and Health Care Insurance
#J-18808-Ljbffr