Provider Engagement & Performance Manager - TN Territory

Tennessee Health Plan; Jackson (TN); On-site; 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 (remote,hyb

Job summary

Centene seeks a Provider Relations Manager to maintain partnerships with contracted networks and drive performance across risk, quality, and cost utilization. You will educate providers, manage provider issues, and lead strategic plans to improve HEDIS/quality measures while coordinating with internal teams.

Travel in Tennessee is required; remote options may apply. Responsibilities include serving as primary contact for providers, triaging issues, educating on referrals and claims, and driving

Qualifications

• Bachelor’s degree in related field or equivalent experience.
• Two years of managed care or medical group experience in provider relations or quality improvement.
• 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 liaise between providers and the health plan.
• Triages provider issues for resolution with internal partners.
• Educate providers on policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics.
• 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, HBR, HEDIS/quality, cost and utilization.
• Completes special projects as assigned.
• Ability to travel locally 4 days a week.
• Complies with all policies and standards.

Skills

Provider relations

Quality improvement

Utilization management

Project management

HEDIS/Quality measures

Data analysis

Education

Bachelor’s degree in related field or equivalent experience

Job description

Centene seeks a Provider Relations Manager to maintain partnerships with contracted networks and drive performance across risk, quality, and cost utilization. You will educate providers, manage provider issues, and lead strategic plans to improve HEDIS/quality measures while coordinating with internal teams.

Travel in Tennessee is required; remote options may apply. Responsibilities include serving as primary contact for providers, triaging issues, educating on referrals and claims, and driving