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Provider Engagement Account Manager – Florida
Build and support Centene’s contracted provider network in Florida. Help providers improve quality, cost, utilization, claims resolution, and network performance.
संयुक्त राज्य
फ़्लोरिडा$56,200 – $1,01,000 / वर्ष
हाइब्रिडपूर्णकालिकजूनियरमध्य स्तरआवश्यक भाषा: अंग्रेज़ीअकाउंट मैनेजरबिक्रीविवरण
- Maintain relationships between the health plan and contracted provider networks
- Build client relationships that support high-quality care for members
- Work with providers to identify network performance opportunities and solutions
- Manage accounts consultatively and take responsibility for resolving issues
- Improve contract incentive results, quality, cost, and utilization
- Act as providers’ main contact and connect them with the health plan
- Route provider issues to the appropriate internal teams
- Address issues raised by external providers
- Investigate and resolve provider claim issues, and communicate related changes
- Update provider demographic information
- Guide providers on referrals, claims submission, website use, EDI solicitation, and related topics
- Lead provider orientations and ongoing education, and create or update orientation materials
- Oversee network performance in an assigned territory through consultative account management
- Assess provider performance and create targeted improvement plans
- Support provider improvement in Risk/P4Q, HBR, HEDIS and quality, cost, and utilization
- Complete special projects and other assigned work
- Follow applicable policies and standards
आवश्यकताएँ
- Applicants must live in one of these Florida counties: Indian River, Martin, Okeechobee, Palm Beach, or St. Lucie
- Bachelor’s degree in a related field or equivalent experience
- Two years of experience in managed care, a medical group, provider relations, quality improvement, claims, contracting, utilization management, or clinical operations
- Project management experience in a medical group, IPA, or health plan setting
- Proficiency in HEDIS and quality measures, cost, and utilization
- Ability to travel locally four days per week
लाभ
- Competitive pay
- Health insurance
- 401(k)
- Stock purchase plans
- Tuition reimbursement
- Paid time off and holidays
- Flexible remote, hybrid, field, or office work schedules
- Additional incentives may be included in total compensation
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