Provider Engagement & Performance Manager - TN

Centene Management Company LLC; Tennessee; Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work arrangements

Job summary

Centene Management Company LLC in Tennessee is seeking a Provider Relations Specialist to maintain partnerships between health plans and contracted provider networks, driving high-quality care and cost-effective utilization across our communities.

You will triage provider issues, educate on policies, manage network performance, and travel locally up to four days a week to support the West Tennessee region.

Qualifications

• Bachelor’s degree in related field or equivalent experience.
• Two 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

• Triages provider issues for resolution with internal partners.
• 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.
• Manage 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 areas such as Risk/P4Q, HBR, HEDIS/quality, cost and utilization.
• Complete special projects as assigned.
• Ability to travel locally 4 days a week.
• Complies with all policies and standards.

Skills

Provider relations

Project management

HEDIS/Quality measures

Communication

Education

Bachelor’s degree or equivalent

Job description

Centene Management Company LLC in Tennessee is seeking a Provider Relations Specialist to maintain partnerships between health plans and contracted provider networks, driving high-quality care and cost-effective utilization across our communities.

You will triage provider issues, educate on policies, manage network performance, and travel locally up to four days a week to support the West Tennessee region.