Remote Provider Performance & Engagement Manager

Centene Corporation; El Paso (TX); Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules (remote,Hybrid

Field or office work

Job summary

Centene Corporation seeks a Provider Relations professional to maintain partnerships between health plans and contracted provider networks. You will build client relationships to ensure high-quality care, align with incentives, and drive performance.

The role emphasizes education, issue resolution, and travel within the assigned territory. The candidate will support provider relations, accuracy in demographic data, and ongoing education while contributing to cost utilization improvements and

Qualifications

• Bachelor's degree or equivalent experience.
• Two years of managed care or medical group experience.
• Experience with HEDIS/Quality measures.
• Experience in provider relations, contracting utilization management, or clinical operations.

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, website 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

HEDIS/Quality measures

Cost & utilization analysis

Project management

Education

Bachelor's degree or equivalent experience

Two years in managed care or medical group experience

Job description

Centene Corporation seeks a Provider Relations professional to maintain partnerships between health plans and contracted provider networks. You will build client relationships to ensure high-quality care, align with incentives, and drive performance.

The role emphasizes education, issue resolution, and travel within the assigned territory. The candidate will support provider relations, accuracy in demographic data, and ongoing education while contributing to cost utilization improvements and