Provider Engagement & Performance Manager

Nebraska Total Care; Nebraska; On-site; USD 56,000 - 101,000; Full time

Job summary

Centene is seeking a Provider Relations professional to maintain partnerships with contracted provider networks and drive performance improvements across quality, cost, and utilization. The role requires extensive Nebraska travel (up to four days weekly) to engage providers, educate on policies, and resolve issues, aligning with health plan strategies.

Ideal candidates hold a bachelor's degree and have 2+ years in managed care, with strong project management skills and proficiency in HEDIS

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 in medical groups, IPA, or health plan setting.
• Proficient in HEDIS/Quality measures, cost and utilization.

Responsibilities

• Serve as primary contact for providers and act as liaison between providers and the health plan.
• Triages provider issues for resolution to internal partners.
• Receive and respond to external provider related issues.
• Investigate, resolve and communicate provider claim issues and 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 updating orientation materials.
• Manage Network performance for assigned territory via consultative/account management approach.
• Evaluate provider performance and develop strategic plans to improve performance.
• Drive provider performance improvement in Risk/P4Q, Quality and Affordability Initiatives, HEDIS/quality, cost and utilization.

Skills

Provider relations

Project management

HEDIS/Quality measures

Cost & utilization

Education

Bachelor’s degree or equivalent experience

Job description

Centene is seeking a Provider Relations professional to maintain partnerships with contracted provider networks and drive performance improvements across quality, cost, and utilization. The role requires extensive Nebraska travel (up to four days weekly) to engage providers, educate on policies, and resolve issues, aligning with health plan strategies.

Ideal candidates hold a bachelor's degree and have 2+ years in managed care, with strong project management skills and proficiency in HEDIS