Senior Provider Engagement Manager – Miami Area

Centene Corporation; Florida; Híbrido; USD 70 000 - 126 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Health insurance

401K

Stock purchase plan

Tuition reimbursement

Paid time off

Flexible work schedules

Resumo da oferta

Centene Corporation is seeking a Provider Relations Manager to develop strategic partnerships between the health plan and contracted provider networks, driving performance, quality, and cost utilization while managing issue resolution.

The role supports Miami and surrounding areas in Florida, requires a Bachelor's degree and 3+ years in managed care, provider relations, quality improvement, or contracting, and strong communication skills. Local travel up to four days a week is expected.

Qualificações

• Bachelor’s degree and 3+ years in managed care, provider relations, quality improvement, claims or contracting.
• Experience in project management within medical groups, IPA, or health plans.
• Strong communication and presentation skills; proficient with HEDIS/quality measures.

Responsabilidades

• Serve as primary contact for providers and act as liaison between providers and health plan for coordinated financial and quality performance improvement.
• Identify and deliver solutions to provider concerns and issues for resolution with internal partners.
• Investigate, resolve and communicate provider claim issues and changes; educate providers on policies and procedures.

Conhecimentos

Strategic partnerships

Account management

Stakeholder communication

HEDIS/Quality measures

Formação académica

Bachelor's degree or equivalent

Descrição da oferta de emprego

Position Purpose:
Develop strategic partnerships between the health plan and the contracted provider networks serving our communities. Engage with providers to align on network performance opportunities and solutions, and consultative account management and accountability for issue resolution. Drive optimal performance in contract incentive performance, quality, and cost utilization. Participate in the development of network management strategies. Assists in the strategic implementation of new initiatives for performance improvement.

Key details: Candidates must live in Florida within Miami Dade county. This role will support Miami and surrounding areas.

• Serve as primary contact for providers and act as a liaison between the providers and the health plan ensuring a coordinated effort in improving financial and quality performance
• Identify and deliver solutions to providers concerns and 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
• Engage with and 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.
• Present detailed HBR analysis and create reports for Joint Operating Committee meetings (JOC)
• Develop proficiency in tools and value based performance (VBP) and educate providers on use of tools and interpretation of data
• Coaches new and less experienced External Reps
• Ability to travel locally 4 days a week
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience:
Bachelor’s degree in related field or equivalent experience.
Three or more 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.
Strong communication and presentation skills
Proficient in HEDIS/Quality measures, cost and utilization.

Pay Range: $70,100.00 - $126,200.00 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