Provider Relations & Network Performance Lead

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

Benefits offered by this job

Competitive pay

Health insurance

401K

Tuition reimbursement

Paid time off

Flexible work schedules

Job summary

Centene is seeking a Provider Relations Manager in Wichita, KS to maintain partnerships between the health plan and provider networks, build client relations, and drive performance on cost, quality, and utilization.

The role requires a bachelor’s degree and at least 2 years of experience in managed care or provider relations, with travel up to four days a week to support network performance and improvement initiatives.

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 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

Managed care

Quality improvement

Claims

Contracting utilization

Project management

Education

Bachelor’s degree or equivalent experience

Job description

Centene is seeking a Provider Relations Manager in Wichita, KS to maintain partnerships between the health plan and provider networks, build client relations, and drive performance on cost, quality, and utilization.

The role requires a bachelor’s degree and at least 2 years of experience in managed care or provider relations, with travel up to four days a week to support network performance and improvement initiatives.