Provider Relations & Performance Manager – Northeast PA

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

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Flexible schedules: remote, hybrid, or

Office or field work

Job summary

Centene Corporation seeks a Provider Relations Manager to maintain partnerships between the health plan and contracted provider networks in Northeast PA. You will build client relations and drive network performance, engaging with providers to align on opportunities and solutions.

The role requires education in a related field and 2+ years in managed care or provider relations, with project management experience and proficiency in HEDIS/quality measures and cost/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.
• 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

Project management

HEDIS/Quality measures

Cost & utilization

Managed care experience

Education

Bachelor's degree or equivalent experience

Job description

Centene Corporation seeks a Provider Relations Manager to maintain partnerships between the health plan and contracted provider networks in Northeast PA. You will build client relations and drive network performance, engaging with providers to align on opportunities and solutions.

The role requires education in a related field and 2+ years in managed care or provider relations, with project management experience and proficiency in HEDIS/quality measures and cost/utilization.