Provider Engagement & Performance Manager - Remote/Travel

Centene Management Company LLC; Omaha (NE); On-site; USD 56,000 - 101,000; Full time

Job summary

Centene Management Company LLC in Omaha, Nebraska seeks an experienced Provider Relations Manager to maintain partnerships between the health plan and contracted provider networks, build client relations, and drive performance in cost utilization and quality.

Travel up to four days per week within Nebraska; you will educate providers on policies, manage provider issues, and lead improvement efforts in HEDIS/Quality and incentive programs.

Qualifications

• Bachelor’s degree in related field or equivalent experience.
• 2 years of managed care or medical group experience in 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 as needed for resolution to internal partners.
• 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 risk, quality and cost initiatives.
• Completes special projects as assigned.

Skills

Provider relations

Project management

Quality improvement

HEDIS/Quality measures

Education

Bachelor’s degree or equivalent experience

Job description

Centene Management Company LLC in Omaha, Nebraska seeks an experienced Provider Relations Manager to maintain partnerships between the health plan and contracted provider networks, build client relations, and drive performance in cost utilization and quality.

Travel up to four days per week within Nebraska; you will educate providers on policies, manage provider issues, and lead improvement efforts in HEDIS/Quality and incentive programs.