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Centene Corporation
Centene Corporation
ConsultingHealthcareInsurance
Centene Corporation is a healthcare and insurance company focused on government-sponsored coverage and community health. Its services include Medicaid, Medicare, Health Insurance Marketplace plans, and TRICARE support for military communities. Centene combines localized care delivery with partnerships with nonprofit organizations to address the needs of the members it serves. The company also incorporates environmental responsibility and ethical governance into its approach to operating and supporting communities.
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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.

USUnited StatesFLFlorida
$56,200 – $101,000 / year
HybridFull-timeJuniorMiddleEnglish RequiredAccount ManagerSales

Description

  • 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

Requirements

  • 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

Benefits

  • 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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