Provider Engagement Manager — Field-Based in NJ

Fidelis Care - New Jersey; New Jersey; On-site; USD 56,000 - 101,000; Full time

Benefits offered by this job

Travel reimbursement

Health benefits

Job summary

Centene is seeking a field-based Provider Relations professional in New Jersey to maintain partnerships with contracted provider networks and drive performance improvements in quality and cost utilization.

The role requires a Bachelor's degree or equivalent and at least two years in managed care or provider relations. Travel within NJ is expected, and the pay range is $56,200 to $101,000 per year.

Qualifications

• Bachelor’s degree in related field or equivalent experience.
• Two years of managed care or medical group experience in provider relations or related areas.
• Proficient in HEDIS/Quality measures, cost and utilization.

Responsibilities

• Serve as primary contact for providers and act as liaison between providers and the health plan.
• Triages provider issues to internal partners for resolution.
• Receive and respond to external provider related issues.
• Investigate, resolve and communicate provider claim issues and changes.
• Educate providers regarding policies and procedures related to referrals and claims submission.
• Perform provider orientations and ongoing education, including 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 risk, HEDIS/quality, cost and utilization.

Skills

Provider relations

Quality improvement

Utilization management

Project management

HEDIS measures

Education

Bachelor’s degree or equivalent

Two years managed care experience

Job description

Centene is seeking a field-based Provider Relations professional in New Jersey to maintain partnerships with contracted provider networks and drive performance improvements in quality and cost utilization.

The role requires a Bachelor's degree or equivalent and at least two years in managed care or provider relations. Travel within NJ is expected, and the pay range is $56,200 to $101,000 per year.