You could be the one who changes everything for our 28 million members.Centene is transforming the health of our communities, one person at a time.As a diversified, national organization, you’ll have access to competitivebenefits including a fresh perspective on workplace flexibility.

• Candidates must live near Kansas City, MO area.
• Position Purpose :
• Maintain partnerships between the health plan and thecontracted provider networks serving our communities. Build client relationsto ensure delivery of the highest level of care to our members. Engage withproviders to align on network performance opportunities and solutions, andconsultative account management and accountability for issue resolution. Driveoptimal performance in contract incentive performance, quality, and costutilization.
• 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 consultativeaccount management approach
• Evaluates provider performance and develops strategic plan to improve performance
• Drives provider performance improvement in the following areas : RiskP4Q, Health Benefit Ratio (HBR), HEDISquality, cost and utilization, etc.
• Completes special projects as assigned
• Ability to travel locally 4 days a week
• Performs other duties as assigned
• Complies with all policies and standards
• EducationExperience :
• Bachelor’s degree in related field or equivalentexperience. Two years of managed care or medical group experience, providerrelations, quality improvement, claims, contracting utilization management, orclinical operations. Project management experience at a medical group, IPA, orhealth plan setting. Proficient in HEDISQuality measures, cost andutilization.Pay Range : $54,000.00 - $97,100.00 per yearCentene offers a comprehensive benefits package including : competitive pay,health insurance, 401K and stock purchase plans, tuition reimbursement, paidtime off plus holidays, and a flexible approach to work with remote, hybrid,field or office work schedules. Actual pay will be adjusted based on anindividuals skills, experience, education, and other job-related factorspermitted by law. Total compensation may also include additional forms ofincentives.Centene is an equal opportunity employer that is committed to diversity, andvalues the ways in which we are different. All qualified applicants willreceive consideration for employment without regard to race, color, religion,sex, sexual orientation, gender identity, national origin, disability, veteranstatus, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered inaccordance with the LA County Ordinance and the California Fair Chance Act