Field-Based Provider Engagement & Performance Manager (TX)

Centene Corporation; Town of Texas (WI); Hybrid; USD 56,000 - 101,000; Full time

Job summary

Centene Corporation seeks a Provider Relations Specialist to manage relationships with provider networks and drive performance improvements in a field-based role.

You will be the primary contact for providers, triage issues, educate on referrals and claims, and develop strategic plans to improve HEDIS/quality metrics, cost utilization, and network performance. Travel locally up to four days a week is required, with remote/hybrid options not guaranteed.

Qualifications

• Bachelor’s degree in related field or equivalent experience.
• Two years of managed care or medical group experience.
• Project management experience in a medical group, IPA, or health plan setting.
• Proficient in HEDIS/Quality measures, cost and utilization.

Responsibilities

• 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
• Perform other duties as assigned
• Complies with all policies and standards

Skills

Provider relations

Account management

HEDIS/Quality measures

Project management

Communication

Education

Bachelor’s degree or equivalent experience

Two years of managed care or medical group experience

Project management experience in medical group/IPA/health plan

Job description

Centene Corporation seeks a Provider Relations Specialist to manage relationships with provider networks and drive performance improvements in a field-based role.

You will be the primary contact for providers, triage issues, educate on referrals and claims, and develop strategic plans to improve HEDIS/quality metrics, cost utilization, and network performance. Travel locally up to four days a week is required, with remote/hybrid options not guaranteed.