Provider Engagement & Network Performance Manager

Centene Management Company LLC; Pennsylvania; 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 + holidays

Remote, hybrid, field or office work

Flexible work schedules

Job summary

Centene is seeking a Provider Relations professional to maintain partnerships between the health plan and contracted networks across Northeast PA, ensuring optimal network performance and issue resolution. You will engage with providers on performance opportunities, educate on policies, and drive improvements in quality, cost, and utilization.

The role requires 2+ years in managed care or related fields, with a Bachelor's degree or equivalent experience, and the ability to travel locally about

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 at 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 develop strategic plan to improve performance.
• Drive provider performance improvement in Risk/P4Q, HBR, 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

Provider relations

Quality improvement

HEDIS/Quality measures

Cost & utilization management

Project management

Education

Bachelor's degree or equivalent experience

2+ years managed care experience

Contracting/utilization management knowledge

Job description

Centene is seeking a Provider Relations professional to maintain partnerships between the health plan and contracted networks across Northeast PA, ensuring optimal network performance and issue resolution. You will engage with providers on performance opportunities, educate on policies, and drive improvements in quality, cost, and utilization.

The role requires 2+ years in managed care or related fields, with a Bachelor's degree or equivalent experience, and the ability to travel locally about