Provider Engagement & Performance Manager - Local Travel

Centene Corporation; Alabama; Hybrid; USD 56,000 - 101,000; Full time

Job summary

Centene Corporation is seeking a Provider Relations professional to maintain partnerships between the health plan and contracted provider networks across Alabama. You will build client relations, educate providers on policies, and drive network performance and cost utilization improvements.

Local travel up to four days weekly is expected. Required are a bachelor’s degree and at least two years in managed care or medical group settings with strong HEDIS/quality measure knowledge.

Qualifications

• Two years of managed care or medical group experience, provider relations, quality improvement, claims, contracting utilization management, or clinical operations.
• Project management experience in a medical group, IPA, or health plan setting.
• Proficient in HEDIS/Quality measures, cost and utilization.

Responsibilities

• Serve as primary contact for providers and liaison between providers and the health plan.
• Triages provider issues 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.
• Manage Network performance for assigned territory through a consultative/account management approach.
• Evaluate provider performance and develop strategic plan to improve performance.
• Drives provider performance improvement in the following areas: Risk/P4Q, HBR, HEDIS/quality, cost and utilization.
• Completes special projects as assigned
• Ability to travel locally 4 days a week
• Performs other duties as assigned
• Complies with all policies and standards

Skills

Provider relations

Quality improvement

Claims

Utilization management

Project management

HEDIS/Quality measures

Cost and utilization

Education

Bachelor’s degree or equivalent experience

Job description

Centene Corporation is seeking a Provider Relations professional to maintain partnerships between the health plan and contracted provider networks across Alabama. You will build client relations, educate providers on policies, and drive network performance and cost utilization improvements.

Local travel up to four days weekly is expected. Required are a bachelor’s degree and at least two years in managed care or medical group settings with strong HEDIS/quality measure knowledge.