Head of Provider Operations

Centene is transforming the health of our communities one person at a time.  As an Executive on our team, you could be the one who changes everything for our 28 million members.
 

Position Purpose:

The Executive will be accountable for the strategic leadership and oversight of all provider network operations, including provider data management, credentialing, and market service excellence. This position is critical to driving operational efficiency, regulatory compliance, and provider engagement across Centene's Enterprise Business Operations Services (EBOS).

• Direct the accurate, timely, and compliant management of provider data, maintaining data integrity and ensuring alignment with Centene EBOS and regulatory standards.
• Oversee and optimize the provider credentialing process, guaranteeing that all provider credentials are current and adhere to internal policies and all applicable regulatory requirements.
• Champion initiatives to advance market service excellence by implementing process improvements and fostering a culture of continuous improvement, with a focus on both provider and member satisfaction.
• Lead and coordinate across the enterprise, facilitating cross-functional collaboration and clear communication to support organizational objectives and drive performance outcomes.
• Ensure unwavering compliance with all healthcare regulations, Centene policies, and standard operating procedures (SOPs), proactively identifying and mitigating potential risks.
• Promote and drive the adoption of industry best practices, leveraging data and analytics to identify opportunities for standardization and operational excellence.
• Establish, monitor, and report on key performance indicators (KPIs), using data-driven insights to lead performance improvement initiatives and ensure achievement of EBOS goals.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience:

• Bachelor's Degree in business administration, healthcare management, or related field or equivalent experience required.
• Master's Degree in a related field preferred.
• Minimum of 15 years’ experience in healthcare operations, with at least 5 years in a leadership capacity overseeing provider network functions.
• Demonstrated expertise in provider data management, credentialing processes, and regulatory compliance within a large healthcare organization.
• Exceptional leadership, communication, and organizational skills, with a proven ability to drive cross-functional collaboration and performance outcomes.
• Proven ability to drive transformation at scale.
• Strategic thinking and advanced problem-solving capabilities.
• Strong analytical skills and meticulous attention to detail.
• Proficiency in provider data operations functions (i.e. credentialling, roster management, issue intake and resolution, etc.).
• Excellent interpersonal, negotiation, and stakeholder engagement skills.
• Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act