Remote Provider Engagement & Performance Manager

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

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Job summary

Centene Corporation is seeking a Provider Relations professional in Mohave County, AZ to maintain partnerships between the health plan and contracted provider networks. The role focuses on building client relations, driving contract incentive performance, quality, and cost utilization while resolving provider issues and educating on policies.

The position requires a bachelor’s degree and two years of managed care or related experience, with travel to support local network performance.

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 in a medical group, IPA, or health plan setting.

Responsibilities

• Serve as primary contact for providers and act as a liaison between the providers and the health plan.
• Triages provider issues for resolution to internal partners.
• Receive and respond to external provider related issues.
• 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.

Skills

Provider relations

Account management

HEDIS/Quality measures

Cost utilization

Project management

Education

Bachelor’s degree

2 years managed care experience

Tools

EDI systems

Job description

Centene Corporation is seeking a Provider Relations professional in Mohave County, AZ to maintain partnerships between the health plan and contracted provider networks. The role focuses on building client relations, driving contract incentive performance, quality, and cost utilization while resolving provider issues and educating on policies.

The position requires a bachelor’s degree and two years of managed care or related experience, with travel to support local network performance.