Strategic Provider Engagement Manager (Indiana)

Centene Corporation; Indiana (PA); Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Health insurance

401K plan

Tuition reimbursement

Paid time off

Flexible schedules

Job summary

Centene Corporation is seeking a Provider Relations professional to maintain partnerships between the health plan and contracted provider networks. The role focuses on elevating care quality, cost utilization, and network performance through consultative account management.

Ideal candidates bring a bachelor’s degree with 2+ years in managed care/provider relations and experience in HEDIS and quality measures. Willingness to travel locally up to four days a week is required.

Qualifications

• Bachelor’s degree in related field or equivalent experience.
• Two years of managed care or medical group experience in provider relations, quality improvement, claims, contracting utilization management, or clinical operations.
• Project management experience in a medical group, IPA, or health plan setting.

Responsibilities

• Serve as primary contact for providers and liaise 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 and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics.
• Travel locally up to 4 days a week.
• Drive provider performance improvement in risk/4Q, HBR, and HEDIS/quality, cost and utilization.
• Complete special projects as assigned.

Skills

Provider relations

HEDIS/Quality measures

Data entry

Education

Bachelor’s degree or equivalent experience

Tools

EDI systems

Job description

Centene Corporation is seeking a Provider Relations professional to maintain partnerships between the health plan and contracted provider networks. The role focuses on elevating care quality, cost utilization, and network performance through consultative account management.

Ideal candidates bring a bachelor’s degree with 2+ years in managed care/provider relations and experience in HEDIS and quality measures. Willingness to travel locally up to four days a week is required.