SC Provider Engagement & Network Performance Manager

Centene Management Company LLC; South Carolina; 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 approach to work with remote,

Job summary

Centene is seeking a Provider Relations Specialist to maintain partnerships between the health plan and contracted provider networks across our South Carolina communities. You will build client relations to ensure high-quality care and act as a liaison for providers, resolving issues and driving performance improvements.

The role requires travel up to four days per week within the region, a bachelor’s degree, and 2+ years in managed care or provider relations.

Qualifications

• Bachelor’s degree or higher; equivalent experience considered.
• 2+ years in managed care/provider relations/quality improvement.
• Project management experience in medical group, IPA, or health plan setting.
• Proficient in HEDIS/Quality measures, cost and utilization.

Responsibilities

• Maintain partnerships between the health plan and contracted provider networks.
• Serve as primary contact for providers and act as liaison between providers and the health plan.
• Triages provider issues for resolution with internal partners.
• Investigate, resolve and communicate provider claim issues and changes.
• Educate providers on policies/procedures for referrals and claims submission, EDI and related topics.
• Travel locally up to 4 days per week to support providers and networks.

Skills

Provider relations

Account management

Quality improvement

Project management

HEDIS/Quality measures

Cost & utilization analysis

Education

Bachelor's degree in related field or equivalent experience

Job description

Centene is seeking a Provider Relations Specialist to maintain partnerships between the health plan and contracted provider networks across our South Carolina communities. You will build client relations to ensure high-quality care and act as a liaison for providers, resolving issues and driving performance improvements.

The role requires travel up to four days per week within the region, a bachelor’s degree, and 2+ years in managed care or provider relations.