Provider Engagement & Performance Manager

Centene Corporation; United States; Remote; USD 56,000 - 101,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Flexible work schedules (remote/hybrid

Job summary

Centene Corporation in Tennessee seeks a Provider Relations professional to maintain partnerships between the health plan and contracted provider networks. You will build client relations to ensure high-quality care, triage issues, educate providers on referrals and claims, and manage network performance across the territory with travel four days per week.

The role requires a bachelor’s degree or equivalent experience and 2+ years in managed care or provider relations, with 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 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 liaison between providers and the health plan.
• Triages provider issues for resolution to internal partners.
• 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 materials.
• Manage Network performance for assigned territory through a consultative/account management approach.
• Evaluate provider performance and develop strategic plan to improve performance.
• Travel locally 4 days a week.

Skills

Provider relations

HEDIS/Quality measures

Cost utilization

Education

Bachelor’s degree or equivalent experience

Tools

Project management

Job description

Centene Corporation in Tennessee seeks a Provider Relations professional to maintain partnerships between the health plan and contracted provider networks. You will build client relations to ensure high-quality care, triage issues, educate providers on referrals and claims, and manage network performance across the territory with travel four days per week.

The role requires a bachelor’s degree or equivalent experience and 2+ years in managed care or provider relations, with proficiency in HEDIS