Job Description

This position has a field component and requires the individual to live in TX. Position Purpose: Maintain partnerships between the health plan and the contracted provider networks serving our communities. Build client relations to ensure delivery of the highest level of care to our members. 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.Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J -1, OPT, or CPT.Serve as primary contact for providers and act as a liaison between the providers and the health planTriages provider issues as needed for resolution to internal partnersReceive and effectively respond to external provider related issuesInvestigate, resolve and communicate provider claim issues and changesInitiate data entry of provider-related demographic information changesEducate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topicsPerform provider orientations and ongoing provider education, including writing and updating orientation materialsManages Network performance for assigned territory through a consultative/account management approachEvaluates provider performance and develops strategic plan to improve performanceDrives provider performance improvement in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc.Completes special projects as assignedAbility to travel locally 4 days a weekPerforms other duties as assignedComplies with all policies and standardsEducation/Experience: Bachelor’s degree in related field or equivalent experience.Two 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.Proficient in HEDIS/Quality measures, cost and utilization.Pay Range: $56,200.00 - $101,000.00 per yearAt Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.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 ActSummaryLocation: Remote-TXType: Full time

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