Provider Relations & Performance Manager

Nebraska Total Care; Omaha (NE); Presencial; USD 56 000 - 101 000; Tempo integral

Resumo da oferta

Centene is seeking a Provider Relations Manager to maintain partnerships between the health plan and contracted provider networks across our communities. You will be the primary contact for providers, triage issues, respond to external inquiries, and work to resolve provider claim changes while promoting referrals and claims education.

The role requires a Bachelor’s degree or equivalent experience, at least two years in managed care or provider relations, and project management experience in a

Qualificações

• Bachelor’s degree or equivalent experience required.
• Minimum two years in managed care, provider relations, quality improvement, claims, contracting utilization management, or clinical operations.
• Project management experience in a medical group, IPA, or health plan setting.
• Proficient in HEDIS/Quality measures, cost and utilization.

Responsabilidades

• 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, Quality and Affordability Initiatives (QAI), 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

Conhecimentos

Provider relations

Quality improvement

Contract management

Education/training

Formação académica

Bachelor’s degree or equivalent experience

2 years managed care or medical group experience

Project management experience

Descrição da oferta de emprego

Centene is seeking a Provider Relations Manager to maintain partnerships between the health plan and contracted provider networks across our communities. You will be the primary contact for providers, triage issues, respond to external inquiries, and work to resolve provider claim changes while promoting referrals and claims education.

The role requires a Bachelor’s degree or equivalent experience, at least two years in managed care or provider relations, and project management experience in a