Manager, Provider Network Operations

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 competitive benefits including a fresh perspective on workplace flexibility.
 

NOTE: We are seeking candidates who live in KS or KC metro area for this role***

Position Purpose: The Manager Provider Network Operations supports all provider network operational activities and ensures compliance with Sunflower Health standards for network participation, state and federal regulatory requirements and accrediting entity standards. This position manages several operational functions as assigned which may include credentialing, contract processing and provider service functions. Monitors the provider onboarding process from end-to-end to ensure operations runs efficiently and effectively and adds support as needed, allocating and distributing work according to department need, to ensure consistency and efficient operations, maintain strategic performance and support process improvement activities among all regions and with matrix partners.

• Monitors all provider network operational functional areas to ensure production is compliant with all internal standards and develops corrective actions plans as needed to address non-compliance.
• Monitors department’s compliance with internal and external corrective actions plans.
• Manages the Provider Network Management dashboard which measures compliance with internal production and department standards
• Takes a lead role in the implementation of new initiatives
• Provides ongoing national/regional process improvement/standardization processes and leverages resources across health plans.
• Manages department operations in compliance with Sunflower Health, state and federal regulatory requirements and accrediting entity standards
• Interprets and coordinates work functions, and establishes standards of performance in order to carry out policy.
• Oversees, develops, manages, and coordinates database/system.
• Oversees compliance, oversight and reporting of monthly departmental key indicators
• Data Management, Provider Network Management, Contracting, Sales, Quality Improvement, Appeals & Grievances and Compliance
• Participates in National Credentialing Advisory Committee, regional Delegation Oversight Committee, Peer Review Committee, Health Net Quality Improvement Committee, and other national/regional steering committees
• Maintains ongoing internal and external communication with subordinates, providers, groups, regulatory bodies and corporate. Coaches and/or staffs on all internal operations including: credentialing, contract administration, corporate policy, national accreditation standards.
• Oversees document submission/review for internal/external requests by legal counsel, regulatory bodies and internal fraud and abuse investigators
• Manages and directs industry collaboration effort (“ICE”) process improvement activities that support collaborative efforts across health plans and medical groups/entities.

Education/Experience: Bachelor’s Degree in Health Care Administration, Business or related field preferred. Minimum five years management or supervisory experience in a progressive leadership role

Pay Range: $84,300.00 - $151,700.00 per year

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.  Total compensation may also include additional forms of incentives.

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