Talent.com
Provider Engagement Account Manager
Provider Engagement Account ManagerSilverSummit Healthplan • Las Vegas, NV, US
Provider Engagement Account Manager

Provider Engagement Account Manager

SilverSummit Healthplan • Las Vegas, NV, US
30+ days ago
Job type
  • Full-time
  • Part-time
Job description

Job Description

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.

  • Remote role, desired candidate resides in Nevada, specifically in Washoe County, Elko County, Clark County, Nye County or surrounding areas . Candidate with a strong claims background, experience in issue resolution or client interaction highly preferred.

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
  • 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.
  • Completes special projects as assigned
  • 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.

    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 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 Act

    Create a job alert for this search

    Provider Engagement Account Manager • Las Vegas, NV, US

    Related jobs
    Senior Technical Account Manager

    Senior Technical Account Manager

    Relativity • Las Vegas, NV, United States
    Full-time
    The Technical Account Management Team proactively supports our customers in meeting their goals and overcoming any technical challenges encountered using the Relativity suite of products.As a membe...Show more
    Last updated: 30+ days ago • Promoted
    Health Partner Engagement Specialist II-Healthcare Account Management Experience- MUST RESIDE IN NORTHERN NEVADA!

    Health Partner Engagement Specialist II-Healthcare Account Management Experience- MUST RESIDE IN NORTHERN NEVADA!

    CareSource • Las Vegas, NV, United States
    Full-time
    The Health Partner Engagement Specialist II collaborates with key Health Partners in the development of specific strategies for enhanced engagements. Health Partner engagement shall be measured by c...Show more
    Last updated: 30+ days ago • Promoted
    Account Manager - Equipment Financing

    Account Manager - Equipment Financing

    Altius Search Group • Las Vegas, NV, United States
    Full-time
    Position : Account Manager (Fully Remote).A leading commercial equipment finance company offers an exciting opportunity for a motivated and skilled Account Manager to join our team.This role focuses...Show more
    Last updated: 30+ days ago • Promoted
    Mental Health Counselor - Remote

    Mental Health Counselor - Remote

    Guideline Healthcare • Henderson, NV, United States
    Remote
    Full-time
    Fully remote licensed Therapist / Counselor opportunities.Great Full-time and Supplement Opportunity!.Therapy focused model with zero administrative work. Perform your work anywhere that has a relia...Show more
    Last updated: 20 days ago • Promoted
    Enterprise Account Management

    Enterprise Account Management

    Shift4 • Las Vegas, NV, US
    Full-time
    Shift4 (NYSE : FOUR) is boldly redefining commerce by simplifying complex payments ecosystems across the world.As the leader in commerce-enabling technology, Shift4 powers billions of transactions a...Show more
    Last updated: 12 days ago • Promoted
    Territory Account Manager

    Territory Account Manager

    Syneos Health / inVentiv Health Commercial LLC • Las Vegas, NV, United States
    Full-time
    You have what it takes : a competitive drive coupled with exceptional sales ability.In this role, you will implement the sales plan by delivering proficient sales presentations to a defined list of ...Show more
    Last updated: 30+ days ago • Promoted
    Provider Relationship Account Manager

    Provider Relationship Account Manager

    Nevada Staffing • Las Vegas, NV, US
    Full-time
    Provider Relationship Account Manager.Be part of an extraordinary team.A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers s...Show more
    Last updated: less than 1 hour ago • Promoted • New!
    Bond / Surety Account Manager

    Bond / Surety Account Manager

    Insurance Office of America • Las Vegas, NV, US
    Full-time
    Title : Account Manager - Bonds / Surety.Longwood, FL, Birmingham, AL, Jupiter, FL, Las Vegas, NV, Atlanta, GA, Charleston, SC, Syracuse, NY or Binghamton, NY office. Please note : If this position is p...Show more
    Last updated: 30+ days ago
    Remote Mental Health Therapist

    Remote Mental Health Therapist

    SonderMind • Coyote Springs, NV, USA
    Remote
    Full-time
    SonderMind is a leading mental health care platform revolutionizing therapy services.We are seeking compassionate and highly skilled licensed mental health therapists to join our expanding network....Show more
    Last updated: 30+ days ago • Promoted
    Account Manager, Interventional Technologies, Boston, MA (South Territory)

    Account Manager, Interventional Technologies, Boston, MA (South Territory)

    Haemonetics • Las Vegas, NV, US
    Full-time
    The Account Manager will be responsible for executing on the strategic and operational plan as directed by Commercial leadership by representing our products to new and existing customers, while ac...Show more
    Last updated: 12 days ago • Promoted
    Account Manager

    Account Manager

    U.S. Lawns • Henderson, NV, United States
    Full-time
    Essential Duties and Responsibilities.Other duties may also be assigned.First respondent to client requests.Evaluates crew leader performance. Coordinates and communicates concerns between office an...Show more
    Last updated: 30+ days ago • Promoted
    Neuropsych Account Specialist - Henderson NV

    Neuropsych Account Specialist - Henderson NV

    Neurocrine Biosciences • Henderson, NV, US
    Full-time
    Neurocrine Biosciences Sales Representative.At Neurocrine Biosciences, we pride ourselves on having a strong, inclusive, and positive culture based on our shared purpose and values.We are dedicated...Show more
    Last updated: 2 days ago • Promoted
    Medical Device Sales Associate Territory Account Manager

    Medical Device Sales Associate Territory Account Manager

    Tactile Medical • Henderson, NV, United States
    Full-time
    Associate Territory Account Manager's.Tactile Medical devices and educating physicians, clinicians and patients on our medical devices that are clinically. Conducts full-cycle consultative sales (pr...Show more
    Last updated: 30+ days ago • Promoted
    Service Account Manager

    Service Account Manager

    Southland Industries • Las Vegas, NV, United States
    Full-time
    We are seeking a dynamic and customer-focused Service Account Manager to join our team.The ideal candidate will develop and maintain positive relationships within assigned customer accounts, overse...Show more
    Last updated: 30+ days ago • Promoted
    BehavioralMental Health Counselor - Remote

    BehavioralMental Health Counselor - Remote

    Guideline Healthcare • Henderson, NV, United States
    Remote
    Full-time
    Fully remote licensed Therapist / Counselor opportunities.Great Full-time and Supplement Opportunity!.Therapy focused model with zero administrative work. Perform your work anywhere that has a relia...Show more
    Last updated: 20 days ago • Promoted
    Account Manager

    Account Manager

    SERVPRO • Henderson, NV, United States
    Full-time
    The Account Manager will play a critical role in driving the growth of our restoration services by building and maintaining strong relationships with key referral accounts.This position will focus ...Show more
    Last updated: 11 days ago • Promoted
    Patient Account Representative

    Patient Account Representative

    Acadia Healthcare • Henderson, NV, United States
    Full-time
    Patient Account Representative.Seven Hills Hospital is a growing, private, 134-bed psychiatric hospital that is dedicated to providing high-quality care for adults, geriatrics, and adolescents (age...Show more
    Last updated: 7 days ago • Promoted
    1099 Engagement ManagersRemote Contract

    1099 Engagement ManagersRemote Contract

    Performance Development Group • Las Vegas, NV, US
    Full-time
    Performance Development Group (PDG) is an award-winning, global leader helping Life Sciences companies improve business results through improving sales performance. Recognized as a premier company i...Show more
    Last updated: 22 days ago • Promoted