Provider Engagement & Performance Manager - West TN

Centene Corporation; Tennessee (IL); 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 schedules

Job summary

Centene Corporation in Tennessee seeks a Provider Relations Manager to maintain partnerships between the health plan and provider networks, driving performance and cost utilization. You will act as primary liaison, triage issues, educate on referrals and claims, and support network improvements.

Requires a bachelor’s degree and 2+ years in managed care, provider relations, or quality improvement; travel up to four days per week within West Tennessee.

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 liaison between providers and health plan.
• Triages provider issues for resolution with internal partners.
• Educate providers on policies, referrals, claims submission, web site usage, EDI topics.
• Manage network performance for assigned territory through a consultative approach.
• Evaluate provider performance and develop plans to improve outcomes.
• Travel locally 4 days a week.

Skills

Provider relations

Quality improvement

Account management

Project management

Education

Bachelor's degree

Job description

Centene Corporation in Tennessee seeks a Provider Relations Manager to maintain partnerships between the health plan and provider networks, driving performance and cost utilization. You will act as primary liaison, triage issues, educate on referrals and claims, and support network improvements.

Requires a bachelor’s degree and 2+ years in managed care, provider relations, or quality improvement; travel up to four days per week within West Tennessee.