Provider Engagement & Performance Manager - Remote/Hybrid

Arizona Complete Health; Arizona; On-site; USD 56,000 - 101,000; Full time

Job summary

Centene in Arizona seeks a Provider Relations Manager to maintain partnerships between the health plan and contracted provider networks. You will serve as primary contact for providers, triage issues, educate on policies, and drive network performance across quality and cost utilization.

Requires a bachelor’s degree (or equivalent) and at least two years in managed care or provider relations, with project management experience. Travel locally up to four days per week.

Qualifications

• Bachelor’s degree in a related field or equivalent experience.
• Two years of managed care or medical group experience.
• 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 as needed for resolution to internal partners.
• Receive and 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 a strategic plan to improve performance.
• Drive provider performance improvement in 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

Project management

Data entry

Education

Bachelor’s degree in related field

Equivalent experience

Job description

Centene in Arizona seeks a Provider Relations Manager to maintain partnerships between the health plan and contracted provider networks. You will serve as primary contact for providers, triage issues, educate on policies, and drive network performance across quality and cost utilization.

Requires a bachelor’s degree (or equivalent) and at least two years in managed care or provider relations, with project management experience. Travel locally up to four days per week.