Provider Engagement & Performance Manager

Centene Management Company LLC; Oklahoma; Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Health insurance

401K plan

Stock purchase plans

Tuition reimbursement

Paid time off

Job summary

Centene Management Company LLC is seeking a Provider Engagement/Performance Manager to strengthen relationships with contracted provider networks and drive performance improvements across risk, quality, and cost metrics. The role emphasizes consultative account management, issue resolution, and education of providers on policies and workflows.

The position requires a bachelor’s degree (or equivalent) with about two years of managed care or medical group experience, and allows for flexible

Qualifications

• Bachelor’s degree in a related field or equivalent experience.
• Two years of managed care or medical group experience in provider relations, quality improvement, claims, contracting utilization management, or clinical operations.
• Project management experience in a medical group, IPA, or health plan setting.
• Proficient in HEDIS/Quality measures, cost and utilization.

Responsibilities

• Maintain partnerships between the health plan and contracted provider networks.
• Serve as primary liaison for providers and triage issues for resolution.
• Investigate, resolve and communicate provider claim issues and changes.
• Educate providers on policies, referrals, claims submission, and related topics.
• Manage network performance through a consultative/account management approach.
• Drive provider performance improvement in risk, HEDIS/quality, cost and utilization.
• Travel locally up to 4 days a week; perform duties as assigned.

Skills

Provider relations

Quality improvement

Claims processing

Contracting utilization management

Clinical operations

Data analytics

Education

Bachelor's degree or equivalent experience

Two years managed care or medical group experience

Job description

Centene Management Company LLC is seeking a Provider Engagement/Performance Manager to strengthen relationships with contracted provider networks and drive performance improvements across risk, quality, and cost metrics. The role emphasizes consultative account management, issue resolution, and education of providers on policies and workflows.

The position requires a bachelor’s degree (or equivalent) with about two years of managed care or medical group experience, and allows for flexible