Provider Engagement & Performance Manager (Hybrid)

PA Health & Wellness; Pennsylvania; On-site; USD 56,000 - 101,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off

Job summary

Centene is hiring a Provider Relations professional to maintain partnerships between the health plan and contracted provider networks in Northeast PA. You will build client relations to ensure high-quality care, drive network performance, and manage provider issues with internal partners. Travel locally about 4 days a week.

The role emphasizes educating providers on policies, coordinating orientations, and improving outcomes across HEDIS, quality, and cost utilization.

Qualifications

• Bachelor’s degree or equivalent experience required.
• 2 years managed care or medical group experience, provider relations, quality improvement, claims, contracting utilization management, or clinical operations.

Responsibilities

• Serve as primary contact for providers and act as a liaison between providers and the health plan.
• Triages provider issues to internal partners for resolution.
• 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 the assigned territory through a consultative/account management approach.
• Evaluate provider performance and develop strategic plans to improve performance.
• Travel locally about 4 days a week.

Skills

Provider relations

Project management

HEDIS/quality measures

Education

Bachelor’s degree in related field or equivalent experience

Job description

Centene is hiring a Provider Relations professional to maintain partnerships between the health plan and contracted provider networks in Northeast PA. You will build client relations to ensure high-quality care, drive network performance, and manage provider issues with internal partners. Travel locally about 4 days a week.

The role emphasizes educating providers on policies, coordinating orientations, and improving outcomes across HEDIS, quality, and cost utilization.