Provider Engagement & Performance Manager (Hybrid)

Centene Management Company LLC; Town of Florida (NY); Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Health insurance

401K

Stock purchase plan

Tuition reimbursement

Paid time off

Holidays

Flexible work options

Job summary

Centene Management Company LLC in Florida is seeking a Provider Relations professional to maintain partnerships with health plan and contracted provider networks, ensuring access to quality care for members.

The role focuses on account management, provider education, resolving provider issues, and improving network performance through HEDIS/quality measures and cost utilization. Local travel up to four days a week is required.

Qualifications

• Bachelor’s degree or related field or equivalent experience.
• Two years of managed care or medical group experience in provider relations or quality.
• Project management experience in medical groups, IPA, or health plans.
• Proficiency with 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 with internal partners.
• Educate providers on policies, referrals, claims submission, and EDI.
• Manage network performance for assigned territory using a consultative approach.
• Evaluate provider performance and develop plans to improve outcomes.
• Travel locally up to four days per week.

Skills

Provider relations

Account management

Project management

HEDIS/Quality measures

Education

Bachelor’s degree or related field

Two years of managed care or medical group experience

Job description

Centene Management Company LLC in Florida is seeking a Provider Relations professional to maintain partnerships with health plan and contracted provider networks, ensuring access to quality care for members.

The role focuses on account management, provider education, resolving provider issues, and improving network performance through HEDIS/quality measures and cost utilization. Local travel up to four days a week is required.