Job Description

Sr. Provider Engagement Account Manager at Sunshine State Health Plan summary:

The Sr. Provider Engagement Account Manager develops strategic partnerships with contracted healthcare providers to improve network performance, quality, and cost utilization in assigned Florida counties. They serve as the primary liaison between providers and the health plan, addressing issues, educating providers, and driving performance improvements through value-based care initiatives. The role involves data analysis, coaching, and managing network strategies to enhance financial and clinical outcomes for the community.

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 Florida (within one of the covered counties).​

This role will cover the following counties Region 6 & 8: Manatee, Charlotte, Sarasota & DeSoto

Position Purpose:
Develop strategic partnerships between the health plan and the contracted provider networks serving our communities. 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. Participate in the development of network management strategies. Assists in the strategic implementation of new initiatives for performance improvement.

• Serve as primary contact for providers and act as a liaison between the providers and the health plan ensuring a coordinated effort in improving financial and quality performance

• Identify and deliver solutions to providers concerns and 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

• Engage with and 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.

• Present detailed HBR analysis and create reports for Joint Operating Committee meetings (JOC)

• Develop proficiency in tools and value based performance (VBP) and educate providers on use of tools and interpretation of data

• Coaches new and less experienced External Reps

• Ability to travel locally 4 days a week

• Performs other duties as assigned

• Complies with all policies and standards

Education/Experience:
Bachelor’s degree in related field or equivalent experience.
Three or more 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.
Strong communication and presentation skills
Proficient in HEDIS/Quality measures, cost and utilization.

Drivers License required

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. Total compensation may also include additional forms of incentives.

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

Keywords:

provider engagement, healthcare account management, network performance, quality improvement, contract management, value-based performance, HEDIS measures, cost utilization, provider relations, managed care

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