Provider Engagement & Performance Manager (TN – Hybrid/Remote)

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

Benefits offered by this job

Health insurance

401K

Stock plan

Tuition reimbursement

PTO & holidays

Flexible schedules

Job summary

Centene Corporation in Tennessee is seeking a Provider Relations professional responsible for maintaining partnerships between the health plan and contracted provider networks. You will build client relations to ensure high-quality care, align on network performance, and drive improvements in cost, utilization, and quality measures across the West Tennessee territory.

The role requires a bachelor’s degree and 2+ years in managed care or provider relations, with project management experience and

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
• 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/P4Q, Health Benefit Ratio (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

Project management

Quality improvement

HEDIS/Quality measures

Cost utilization

Communication

Education

Bachelor’s degree in related field

Job description

Centene Corporation in Tennessee is seeking a Provider Relations professional responsible for maintaining partnerships between the health plan and contracted provider networks. You will build client relations to ensure high-quality care, align on network performance, and drive improvements in cost, utilization, and quality measures across the West Tennessee territory.

The role requires a bachelor’s degree and 2+ years in managed care or provider relations, with project management experience and