Strategic Provider Relations Manager - Hybrid/Remote

Centene Corporation; Indianapolis (IN); Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Job summary

Centene Corporation seeks a Provider Relations Manager to maintain partnerships between the health plan and contracted provider networks. You will build client relations to ensure delivery of high-quality care and align with network performance opportunities.

You will travel locally up to four days a week, triage provider issues, educate on policies, and drive performance improvements across risk, HEDIS, and cost utilization.

Qualifications

• Bachelor’s degree in related field 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.

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, website 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 areas of Risk/P4Q, HBR, HEDIS/quality, cost and utilization.
• Completes special projects as assigned.
• Ability to travel locally 4 days a week.

Skills

HEDIS/Quality measures

Education

Bachelor’s degree in related field

Job description

Centene Corporation seeks a Provider Relations Manager to maintain partnerships between the health plan and contracted provider networks. You will build client relations to ensure delivery of high-quality care and align with network performance opportunities.

You will travel locally up to four days a week, triage provider issues, educate on policies, and drive performance improvements across risk, HEDIS, and cost utilization.