Provider Engagement & Network Performance Manager

Centene Corporation; Town of Texas (WI); Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Health insurance

401K

Stock purchase plan

Tuition reimbursement

Paid time off

Holidays

Flexible work arrangements

Job summary

Centene Corporation is seeking a field-based professional to maintain partnerships between the health plan and contracted provider networks across Texas counties. You will build client relations to ensure high-quality care, address provider issues, and drive performance in cost and utilization.

Role requires a bachelor's degree or equivalent and 2+ years in managed care or provider relations; HEDIS/quality measures proficiency is expected.

Qualifications

• Bachelor’s degree or equivalent experience and 2+ years in managed care or provider relations.
• Proficient in HEDIS/Quality measures, cost and utilization.
• Experience in contracts, utilization management or project management in medical settings.

Responsibilities

• Serve as primary contact for providers and act as liaison between providers and the health plan.
• Triages provider issues for resolution with internal partners.
• Educate providers on policies, referrals, claims submission, EDI and related topics.
• Conduct provider orientations and ongoing education, updating materials as needed.
• Manage network performance for assigned territory with a consultative approach.
• Evaluate provider performance and develop plans to improve outcomes.
• Drive performance in risk/quality, cost and utilization metrics.
• Travel locally about 4 days per week and perform other duties as assigned.

Skills

Provider relations

Quality improvement

Claims processing

Contracting

Utilization management

Project management

Managed care

Education

Bachelor's degree or equivalent

Job description

Centene Corporation is seeking a field-based professional to maintain partnerships between the health plan and contracted provider networks across Texas counties. You will build client relations to ensure high-quality care, address provider issues, and drive performance in cost and utilization.

Role requires a bachelor's degree or equivalent and 2+ years in managed care or provider relations; HEDIS/quality measures proficiency is expected.