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Centene Corporation
Centene Corporation
DraudimasKonsultavimasSveikatos priežiūra
„Centene Corporation“ yra sveikatos priežiūros ir draudimo bendrovė, daugiausia dėmesio skirianti valstybės remiamam draudimui ir bendruomenių sveikatai. Jos paslaugos apima „Medicaid“, „Medicare“, „Health Insurance Marketplace“ planus ir TRICARE paramą kariuomenės bendruomenėms. „Centene“ derina vietos lygmeniu teikiamą priežiūrą su partneryste su ne pelno organizacijomis, kad patenkintų aptarnaujamų narių poreikius. Vykdydama veiklą ir remdama bendruomenes, bendrovė taip pat atsižvelgia į aplinkosaugą ir etišką valdymą.
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Provider Engagement Account Manager - Kansas Remote

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

USJungtinės ValstijosKSKanzasas
56 200 $ – 101 000 $ / metai
NuotolinisVisas etatasJaunesnysis specialistasVidutinis lygisPrivaloma Kalba: anglųKlientų vadybininkasPardavimai

Aprašymas

  • 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

Reikalavimai

  • 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

Privalumai

  • 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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USJungtinės ValstijosCOKoloradas
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