Provider Engagement & Network Manager – West Tennessee

Tennessee Health Plan; Murfreesboro (TN); Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible approach to remote, hybrid,/5

Job summary

Centene is seeking a Provider Relations professional to maintain partnerships between the Tennessee Health Plan and contracted provider networks, ensuring high quality care for members. You will build client relations, align incentives, and drive network performance across West Tennessee.

The role requires residency in Tennessee with travel up to four days per week and a strong background in managed care, provider relations, and quality improvement.

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.
• 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.
• Manage Network performance for assigned territory through a consultative/account management approach.
• Evaluate provider performance and develops strategic plan to improve performance.
• Drive provider performance improvement in risk, HEDIS/quality, cost and utilization.
• Complete special projects as assigned.
• Ability to travel locally 4 days a week.
• Performs other duties as assigned.
• Complies with all policies and standards.

Skills

HEDIS/Quality measures

Cost and utilization

Project management

Education

Bachelor’s degree in related field or equivalent experience

Job description

Centene is seeking a Provider Relations professional to maintain partnerships between the Tennessee Health Plan and contracted provider networks, ensuring high quality care for members. You will build client relations, align incentives, and drive network performance across West Tennessee.

The role requires residency in Tennessee with travel up to four days per week and a strong background in managed care, provider relations, and quality improvement.