Centene Corporation
Centene Corporation
Centene Corporation — үкімет қаржыландыратын медициналық сақтандыруға және қоғам денсаулығына бағытталған денсаулық сақтау және сақтандыру компаниясы. Оның қызметтеріне Medicaid, Medicare, медициналық сақтандыру маркетплейсінің жоспарлары және әскери қауымдастықтарға арналған TRICARE қолдауы кіреді. Centene қызмет көрсететін мүшелердің қажеттіліктерін қанағаттандыру үшін жергілікті медициналық көмек көрсетуді коммерциялық емес ұйымдармен серіктестікпен ұштастырады. Компания сондай-ақ өз қызметін жүргізу және қауымдастықтарды қолдау тәсіліне экологиялық жауапкершілік пен этикалық басқару қағидаттарын енгізеді.

Provider Engagement Account Manager - Kansas Remote

Manage Centene’s provider partnerships across Kansas while improving network quality, cost utilization, claims resolution, and performance outcomes.

Сипаттама

  • Manage relationships between the health plan and contracted provider networks
  • Develop client relationships that support high-quality member care
  • Work with providers to identify network performance opportunities and solutions
  • Deliver consultative account management and oversee issue resolution
  • Improve contract incentive performance, quality, and cost utilization
  • Act as the primary provider contact and health-plan liaison
  • Route provider concerns to internal teams for resolution
  • Address issues raised by external providers
  • Investigate, resolve, and communicate provider claim issues and updates
  • Record changes to provider demographic information
  • Educate providers about referrals, claims submission, website functions, EDI solicitation, and related processes
  • Lead provider orientations and continuing education
  • Create and maintain orientation materials
  • Oversee network performance within the assigned territory
  • Assess provider performance and create strategic improvement plans
  • Advance Risk/P4Q, Health Benefit Ratio, HEDIS/quality, cost, and utilization results
  • Complete special projects and other assigned responsibilities
  • Follow applicable policies and standards

Талаптар

  • Bachelor’s degree in a related field or equivalent experience
  • Two years of experience in managed care or medical groups, provider relations, quality improvement, claims, contracting utilization management, or clinical operations
  • Project management experience in a medical group, IPA, or health-plan environment
  • Proficiency with HEDIS and quality measures, cost, and utilization
  • Preferred knowledge of Kansas HCBS and LTSS waiver programs, including eligibility, service delivery, and regulatory requirements
  • Residence in Kansas City, Kansas is required
  • Willingness to travel locally four days per week

Артықшылықтар

  • Competitive compensation
  • Health insurance
  • 401(k) plan
  • Employee stock purchase plans
  • Tuition reimbursement
  • Paid time off and holidays
  • Flexible remote, hybrid, field, or office work arrangements
  • Additional incentives may form part of total compensation
  • Equal opportunity and diversity commitment

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