Provider Engagement & Performance Manager - TN

Centene Corporation; Nashville (TN); On-site; USD 56,000 - 101,000; Full time

Benefits offered by this job

Health insurance

401K and stock plans

Tuition reimbursement

Paid time off and holidays

Flexible work schedules

Job summary

Centene Corporation in Tennessee seeks a Provider Relations Manager to maintain partnerships between the health plan and contracted provider networks, driving high-quality care and efficient claims processing.

The role requires travel up to four days weekly within West Tennessee, with extensive provider education and performance improvement responsibilities and a strong focus on HEDIS and cost utilization.

Qualifications

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

Responsibilities

• 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
• 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, 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

Education

Bachelor’s degree in related field or equivalent experience

Job description

Centene Corporation in Tennessee seeks a Provider Relations Manager to maintain partnerships between the health plan and contracted provider networks, driving high-quality care and efficient claims processing.

The role requires travel up to four days weekly within West Tennessee, with extensive provider education and performance improvement responsibilities and a strong focus on HEDIS and cost utilization.