Provider Engagement & Performance Lead

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

Job summary

Centene seeks a provider relations professional with a background in managed care to strengthen partnerships between health plans and provider networks. The role offers field responsibilities, ongoing education for providers, and a focus on network performance and cost utilization.

Requires a Bachelor's or equivalent experience; two years in managed care or related areas; capable of project management in medical group or health plan settings. Travel up to four days per week.

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 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, website 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, HEDIS/quality, cost and utilization.

Education

Bachelor’s degree or equivalent experience

Project management experience

Provider relations

Account management

HEDIS/Quality measures knowledge

Job description

Centene seeks a provider relations professional with a background in managed care to strengthen partnerships between health plans and provider networks. The role offers field responsibilities, ongoing education for providers, and a focus on network performance and cost utilization.

Requires a Bachelor's or equivalent experience; two years in managed care or related areas; capable of project management in medical group or health plan settings. Travel up to four days per week.