Provider Engagement & Quality Improvement Lead

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

Benefits offered by this job

Health insurance

401K

Tuition reimbursement

Paid time off

Flexible work arrangements

Job summary

Centene Management Company LLC is seeking a Provider Relations professional to maintain partnerships between the health plan and contracted provider networks, with a focus on Arizona. You will build strong relationships to ensure high-quality care and align on network performance opportunities.

Responsibilities include serving as primary contact for providers, triaging issues, educating on referrals and claims, and driving improvements in HEDIS/quality, cost and 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 the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc.
• 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

Quality improvement

Project management

HEDIS/Quality measures

Cost and utilization

Education

Bachelor’s degree in related field

Job description

Centene Management Company LLC is seeking a Provider Relations professional to maintain partnerships between the health plan and contracted provider networks, with a focus on Arizona. You will build strong relationships to ensure high-quality care and align on network performance opportunities.

Responsibilities include serving as primary contact for providers, triaging issues, educating on referrals and claims, and driving improvements in HEDIS/quality, cost and utilization.