Provider Engagement & Performance Manager (Hybrid/Remote)

Centene Corporation; Austin (TX); Vor Ort; USD 56.000 - 101.000; Vollzeit

Zusammenfassung

Centene Corporation seeks a Provider Relations professional to maintain partnerships between the health plan and contracted provider networks serving our communities. You will build client relations and drive network performance opportunities while demonstrating accountability for issue resolution.

Role requires travel up to four days a week and a Bachelor’s degree with two years in managed care or related fields.

Qualifikationen

• 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 or project management experience at a medical group, IPA, or health plan setting.
• Proficient in HEDIS/Quality measures, cost and utilization.

Aufgaben

• Serve as primary contact for providers and act as a liaison between the providers and the health plan.
• Triages provider issues as needed for resolution to internal partners.
• Receive and effectively respond to external provider related issues.
• Investigate, resolve and communicate provider claim issues and changes.
• Initiate data entry of provider-related demographic information 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 writing and updating orientation materials.
• Manages Network performance for assigned territory through a consultative/account management approach.
• Evaluates provider performance and develops strategic plan to improve performance.
• Drives provider performance improvement in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc.
• Completes special projects as assigned.
• Ability to travel locally 4 days a week.
• Performs other duties as assigned.
• Complies with all policies and standards.

Kenntnisse

2 years managed care experience

HEDIS/Quality measures

Cost and utilization analysis

Ausbildung

Bachelor’s degree or equivalent experience

Jobbeschreibung

Centene Corporation seeks a Provider Relations professional to maintain partnerships between the health plan and contracted provider networks serving our communities. You will build client relations and drive network performance opportunities while demonstrating accountability for issue resolution.

Role requires travel up to four days a week and a Bachelor’s degree with two years in managed care or related fields.