Strategic Provider Engagement & Performance Manager

Centene Corporation; Topeka (KS); On-site; USD 56,000 - 101,000; Full time

Benefits offered by this job

Health insurance

401K

Stock purchase plans

Tuition reimbursement

Paid time off

Flexible schedules

Job summary

Centene Corporation in Kansas City, KS seeks a Provider Relations Specialist to maintain partnerships between the health plan and contracted provider networks. You will build client relations to ensure delivery of high-quality care and engage with providers to align on performance opportunities and accountability.

Role involves traveling locally up to four days a week, triaging provider issues, educating providers on policies, and managing network performance with a consultative approach.

Qualifications

• Bachelor's degree or equivalent experience.
• Two years of managed care or medical group experience, provider relations, quality improvement, claims, contracting utilization management, or clinical operations.
• Project management experience in a medical group, IPA, or health plan setting.
• Proficient in HEDIS/Quality measures, cost and utilization.
• Strong understanding of Kansas HCBS and LTSS waiver programs, including eligibility, service delivery, and regulatory requirements (preferred).

Responsibilities

• Serve as primary contact for providers and act as a liaison between the providers and the health plan.
• Triages provider 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.
• Initiate data entry of provider-related demographic information changes.
• 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 areas: Risk/P4Q, HBR, HEDIS/quality, cost and utilization.
• Completes special projects as assigned.
• Ability to travel locally 4 days a week.
• Performs other duties as assigned.
• Complies with all policies and standards.

Skills

Project management

HEDIS/Quality measures

Cost and utilization

Education

Bachelor's degree or equivalent experience

Job description

Centene Corporation in Kansas City, KS seeks a Provider Relations Specialist to maintain partnerships between the health plan and contracted provider networks. You will build client relations to ensure delivery of high-quality care and engage with providers to align on performance opportunities and accountability.

Role involves traveling locally up to four days a week, triaging provider issues, educating providers on policies, and managing network performance with a consultative approach.