serp_jobs.breadcrumb.workplace_remote Account manager serp_jobs.h1.location_city

Provider Network Manager

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.

Candidates must reside in Texas.

This role will cover the following counties : Hidalgo Service Delivery Area : Cameron, Duval, Hidalgo, Jim Hogg, Maverick, McMullen, Starr, Webb, Willacy, Zapata.

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 include :

• 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.

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, 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