Job Details

Join to apply for the Provider Engagement Account Manager role at Ohana Health Plan.

4 days ago Be among the first 25 applicants.

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 Hawaii.

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.

• Serve as primary contact for providers and act as a liaison between the providers and the health plan.
• Triages provider 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.
• Initiate data entry of provider-related demographic information changes.
• 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.
• Manage network performance for assigned territory through a consultative/account management approach.
• Evaluate provider performance and develop strategic plans to improve performance.
• Drive provider performance improvement in areas like Risk/P4Q, HBR, HEDIS/quality, cost, and utilization.
• Complete special projects as assigned.
• Ability to travel locally 4 days a week.
• Perform other duties as assigned.
• Comply with all policies and standards.

Education/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: $55,100.00 - $99,000.00 per year.

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 skills, experience, education, and other factors. Total compensation may include additional incentives.

Centene is an equal opportunity employer that values diversity. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics.

Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws.

Additional Details

• Seniority level: Not Applicable
• Employment type: Full-time
• Job function: Sales and Business Development
• Industries: Hospitals and Health Care, Insurance

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