Senior Manager, Credentialing & Provider Data Management Systems

Centene Corporation; Missouri; Hybrid; USD 88,000 - 158,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Job summary

Centene Corporation is seeking a Senior Manager of Credentialing and Provider Data Management to oversee credentialing and provider data entry from triage through enrollment and ongoing maintenance. The role requires a strong technical background and leadership of a technical team.

Responsibilities include direct oversight of credentialing and re-credentialing for physicians and providers, management of provider data policies, and ensuring compliance with NCQA and state/federal requirements.

Qualifications

• Bachelor’s degree or equivalent experience; NCQA credentialing knowledge required.
• 3+ years supervisory/management experience.

Responsibilities

• Lead a team supporting credentialing and provider data management from a technical perspective including system updates, data analysis, and reporting.
• Direct oversight for credentialing and re-credentialing of physicians, mid-level practitioners and organizational providers.
• Oversee all activities related to provider data management including training materials, policies, and procedures.
• Ensure updates for provider records in line with health plan policies and state/federal regulations.
• Ensure compliance with KPIs, NCQA credentialing standards and state/federal requirements.
• Manage updates to and production of provider directories.
• Ensure accuracy of provider enrollment specifications and demographics.

Skills

SQL Server

Provider data management

Credentialing

Leadership

Technical team leadership

Education

Bachelor's degree or equivalent experience

NCQA credentialing knowledge

Tools

Portico

Amisys

CenProv

Job description

Position Purpose: The Senior Manager of Credentialing and PDM will oversee all direct processes of credentialing and provider data entry, from triage through provider enrollment and data maintenance.

Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

Preferred qualifications include a strong technical background, experience leading technical teams, hands‑on expertise with SQL Server, and knowledge of provider data management (PDM), credentialing, and managed care operations.

• This role will focus on leading a team that supports the credentialing and provider data management organization from a technical perspective including system updates and enhancements, data analysis, and reporting.
• Direct oversight for credentialing and re‑credentialing of all physicians, mid‑level practitioners and organizational providers.
• Oversee all activities related to the management of provider data, including the development and management of training materials, policies, and procedures.
• Ensure updates (adds, changes, and terminations) for new or existing provider records are made in accordance with health plan policies and state/federal regulations.
• Ensure compliance with key performance indicators established by corporate office, NCQA credentialing standards, and state/federal requirements.
• Manage updates to and production of hard copy and online provider directories.
• Ensure accuracy of provider enrollment specifications and specialty types and demographics.

Education/Experience: Bachelor’s degree or equivalent experience and 4 years of relevant experience. NCQA, credentialing, and provider data management knowledge required. 3+ years of supervisory/management experience. Preferred experience with Portico, Amisys, CenProv. Pay Range: $87,700.00 - $157,800.00 per year

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day.You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job‑related factors permitted by law, including full‑time or part‑time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act