Strategic Lead, Credentialing & Provider Data Analytics

Centene Management Company LLC; Missouri; Hybrid; USD 88,000 - 158,000; Full time

Job summary

Centene seeks a Senior Manager of Credentialing and Provider Data Management to oversee credentialing processes, provider data entry and enrollment, with a focus on regulatory compliance and data accuracy.

Lead a technical team, drive system updates, reporting and training materials while ensuring adherence to NCQA standards and state regulations. This role supports comprehensive provider data operations across our health plan network.

Qualifications

• Bachelor's degree or equivalent experience.
• 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.

Responsibilities

• Oversee credentialing and provider data management from triage to enrollment and data maintenance.
• Lead a team supporting credentialing and provider data management with system updates, data analysis and reporting.
• Ensure accuracy of provider enrollment specifications, specialties and demographics.
• Develop and manage training materials, policies and procedures for provider data management.
• Ensure updates to provider records comply with health plan policies and state/federal regulations.
• Monitor KPIs and NCQA credentialing standards compliance.
• Produce updates to hard copy and online provider directories.

Skills

Provider data management

Credentialing

Team leadership

Education

Bachelor's degree

Tools

Portico

Amisys

CenProv

SQL Server

Job description

Centene seeks a Senior Manager of Credentialing and Provider Data Management to oversee credentialing processes, provider data entry and enrollment, with a focus on regulatory compliance and data accuracy.

Lead a technical team, drive system updates, reporting and training materials while ensuring adherence to NCQA standards and state regulations. This role supports comprehensive provider data operations across our health plan network.