Provider Engagement & Network Performance Manager

Centene Corporation; Clifton (TX); On-site; USD 56,000 - 101,000; Full time

Job summary

Centene Corporation seeks a Provider Relations Manager to maintain partnerships between the health plan and contracted provider networks in Texas. You will build client relations to ensure high-quality care for our members and drive performance in contract incentives, quality, and cost utilization.

The role requires living in TX, traveling locally four days a week, and strong experience in managed care, provider relations, and quality improvement.

Qualifications

• Two years of managed care or medical group experience.
• Experience in provider relations, quality improvement, or claims utilization management.
• PM experience in a medical group/IPA/health plan setting.

Responsibilities

• Serve as primary contact for providers and liaison between providers and the health plan.
• Triages provider issues for resolution with internal partners.
• Educate providers regarding policies, procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics.
• Perform provider orientations and ongoing provider education, including updating orientation materials.
• Manage Network performance for assigned territory through a consultative/account management approach.
• Evaluate provider performance and develop strategic plans to improve performance.
• Drives provider performance improvement in Risk/P4Q, HBR, HEDIS/quality, cost and utilization.
• Completes special projects as assigned.
• Ability to travel locally 4 days a week.
• Performs other duties as assigned.
• Complies with all policies and standards.

Skills

Provider relations

Quality improvement

Claims

Utilization management

Project management

HEDIS/Quality measures

Education

Bachelor's degree in related field or equivalent experience

Job description

Centene Corporation seeks a Provider Relations Manager to maintain partnerships between the health plan and contracted provider networks in Texas. You will build client relations to ensure high-quality care for our members and drive performance in contract incentives, quality, and cost utilization.

The role requires living in TX, traveling locally four days a week, and strong experience in managed care, provider relations, and quality improvement.