Provider Network Engagement & Performance Manager

Centene Corporation; Trenton (NJ); Sur place; USD 56 000 - 101 000; Plein temps

Avantages offerts par ce poste

Health insurance

401K

Stock purchase plan

Tuition reimbursement

Paid time off

Flexible schedules

Résumé du poste

Centene Corporation is seeking a field-based Provider Relations Specialist to reside in New Jersey. You will act as the primary liaison between providers and the health plan, triage issues, educate on policies, and drive performance improvements across risk, HEDIS, and utilization.

You will manage provider relations for a specific territory, handle claims and demographic changes, and collaborate with internal partners to resolve problems. Travel up to four days weekly is required.

Qualifications

• Bachelor’s degree in related field or equivalent experience.
• Two years of managed care or medical group experience.
• Proficient in HEDIS/Quality measures, cost and utilization.

Responsabilités

• Serve as primary contact for providers and liaison between providers and the health plan
• Triages provider issues for resolution to internal partners
• 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
• Educate providers and conduct orientations for ongoing education
• Manage network performance for assigned territory through a consultative/account management approach
• Evaluate provider performance and develop a strategic plan to improve performance
• Drives provider performance improvement in risk/P4Q, HBR, quality and utilization
• Complete special projects as assigned
• Ability to travel locally 4 days a week

Connaissances

Provider relations

Quality improvement

HEDIS knowledge

Data entry

Formation

Bachelor’s degree or equivalent

Outils

EDI

Description du poste

Centene Corporation is seeking a field-based Provider Relations Specialist to reside in New Jersey. You will act as the primary liaison between providers and the health plan, triage issues, educate on policies, and drive performance improvements across risk, HEDIS, and utilization.

You will manage provider relations for a specific territory, handle claims and demographic changes, and collaborate with internal partners to resolve problems. Travel up to four days weekly is required.