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Sunshine Health · 1 day ago

Senior Provider Engagement Account Manager

Florida, United States

Full-time

Hybrid

Mid, Senior Level

$70K/yr - $126K/yr

3+ years exp

Sunshine Health is part of Centene, a national organization transforming the health of communities. The Senior Provider Engagement Account Manager will develop strategic partnerships with contracted provider networks, ensuring improved performance and accountability in financial and quality metrics.

Hospital & Health Care

Responsibilities

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

Direct Provider Engagement Conducts regular in-person visits with physicians to provide real-time support, discuss performance metrics, and identify opportunities for improvement in patient care and clinical practices

Value-Based Care Model Focuses on value-based care model initiatives, collaborating with physicians to identify and align to performance-based agreements that incentivize better patient outcomes, cost-efficiency, and quality care

Performance Management Uses data analytics to track and monitor provider performance, offering actionable feedback to help physicians optimize care delivery and meet key performance targets

Qualification

Provider relationsPerformance managementValue-based care modelHEDIS/Quality measuresData analyticsCommunicationPresentation skillsProject management

Required

Candidates must reside in Florida (within one of the covered counties)

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

Ability to travel locally 4 days a week