Provider Relations & Performance Manager — NJ Field-Based

Centene Corporation; New Jersey; Hybrid; USD 56,000 - 101,000; Full time

Job summary

Centene Corporation is seeking a field-based professional in New Jersey to maintain partnerships between our health plan and contracted provider networks. You will build client relations to ensure top-tier care for members, educate providers on policies and claims processes, and drive network performance and quality improvements.

The role requires a Bachelor’s degree (or equivalent) and at least two years in managed care or related provider relations roles.

Qualifications

• Two years of managed care or medical group experience and experience with provider relations, quality improvement, claims, contracting utilization management, or project management in 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.
• 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 risks, HEDIS/quality, cost and utilization.
• Completes special projects as assigned.
• Ability to travel locally 4 days a week.
• Complies with all policies and standards.

Skills

HEDIS/Quality measures

Cost and utilization

Education

Bachelor's degree or equivalent experience

Job description

Centene Corporation is seeking a field-based professional in New Jersey to maintain partnerships between our health plan and contracted provider networks. You will build client relations to ensure top-tier care for members, educate providers on policies and claims processes, and drive network performance and quality improvements.

The role requires a Bachelor’s degree (or equivalent) and at least two years in managed care or related provider relations roles.