Provider Engagement & Network Performance Manager

Centene Corporation; Kansas; Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Health insurance

401K

Stock purchase

Tuition reimbursement

Paid time off

Flexible schedule

Job summary

Centene Corporation in Wichita, KS is seeking a Provider Relations Manager to maintain partnerships between the health plan and provider networks. You will serve as primary contact for providers, triage issues, and drive network performance through a consultative approach.

The role requires a bachelor’s degree and at least two years in managed care or provider relations, with experience in project management and HEDIS/quality measures. Travel up to four days a week is expected.

Qualifications

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

Responsibilities

• Serve as primary contact for providers and liaison between providers and the health plan.
• Triages provider issues for resolution with internal partners.
• Respond to external provider related issues and educate on policies.
• Investigate and communicate provider claim issues and changes.
• Enter provider-related demographic information changes.
• Educate providers on referrals, claims submission, and EDI topics.
• Conduct provider orientations and updates to materials.
• Manage network performance for assigned territory via consultative account management.
• Evaluate provider performance and develop plans to improve performance.
• Drive provider performance in Risk/P4Q, HEDIS/quality, cost/utilization.

Skills

Provider relations

Quality improvement

Project management

HEDIS/quality measures

Education

Bachelor’s degree or equivalent experience

Job description

Centene Corporation in Wichita, KS is seeking a Provider Relations Manager to maintain partnerships between the health plan and provider networks. You will serve as primary contact for providers, triage issues, and drive network performance through a consultative approach.

The role requires a bachelor’s degree and at least two years in managed care or provider relations, with experience in project management and HEDIS/quality measures. Travel up to four days a week is expected.