Provider Engagement & Performance Manager (Hybrid/Remote)

Centene Management Company LLC; United States; Hybrid; 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 arrangements

Job summary

Centene Management Company LLC is seeking a Provider Relations professional to maintain partnerships with health plan providers and drive network performance. You will serve as the primary contact for providers, triaging issues, educating on policies, and managing performance in a consultative manner.

The role requires a Bachelor’s degree and at least two years in managed care or provider relations, with travel up to 4 days weekly. A strong understanding of HEDIS/quality measures is important.

Qualifications

• Bachelor’s degree in related field or equivalent experience.
• Two years in managed care, provider relations or related operations.
• Proficient in HEDIS/Quality measures, cost and utilization.

Responsibilities

• Triages provider issues as needed for resolution.
• Receive and respond to external provider issues.
• Investigate, resolve and communicate provider claim issues.
• Educate providers on referrals, claims submission, and EDI topics.
• Initiate data entry of provider-related demographic changes.
• Travel locally up to 4 days a week.

Skills

Provider relations

Quality improvement

Project management

HEDIS measures

Utilization

Education

Bachelor’s degree or equivalent

Job description

Centene Management Company LLC is seeking a Provider Relations professional to maintain partnerships with health plan providers and drive network performance. You will serve as the primary contact for providers, triaging issues, educating on policies, and managing performance in a consultative manner.

The role requires a Bachelor’s degree and at least two years in managed care or provider relations, with travel up to 4 days weekly. A strong understanding of HEDIS/quality measures is important.