Field-Based Provider Engagement Manager - Remote/Hybrid

Centene Management Company LLC; Georgia; Hybrid; USD 56,000 - 101,000; Full time

Job summary

Centene is seeking a field-based Provider Relations professional to maintain partnerships between our health plan and contracted provider networks across a 30-county North Georgia territory. The role requires travel within GA and acts as the primary liaison for providers, focusing on performance, cost, and quality improvements.

Qualifications include a Bachelor's degree or equivalent experience and 2+ years in managed care, provider relations, or related areas with proficiency in HEDIS/Quality

Qualifications

• 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 in a medical group, IPA, or health plan setting.

Responsibilities

• Triages provider issues for resolution to internal partners.
• Respond to external provider related issues.
• Investigate, resolve and communicate provider claim issues and changes.
• Educate providers regarding referrals, claims submission, and related topics.
• Provider orientations and ongoing provider education, including materials.
• Manage network performance for the territory through a consultative approach.
• Evaluate provider performance and develop plans to improve performance.
• Travel locally 4 days a week.

Skills

Provider relations

Quality improvement

Account management

HEDIS/Quality measures

Risk Adjustment

VBC knowledge

Education

Bachelor’s degree in related field or equivalent experience

Job description

Centene is seeking a field-based Provider Relations professional to maintain partnerships between our health plan and contracted provider networks across a 30-county North Georgia territory. The role requires travel within GA and acts as the primary liaison for providers, focusing on performance, cost, and quality improvements.

Qualifications include a Bachelor's degree or equivalent experience and 2+ years in managed care, provider relations, or related areas with proficiency in HEDIS/Quality