Position Purpose: Maintain partnerships between the health plan and the contracted provider networks serving our communities. Build client relations to ensure delivery of the highest level of care to our members. Engage with providers to align on network performance opportunities and solutions, and consultative account management and accountability for issue resolution. Drive optimal performance in contract incentive performance, quality, and cost utilization.
Key details: Candidates must live in Tennessee (TN). This role will support the
lower half of West Tennessee (Shelby county).
- 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 the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, 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
Two years of managed care or medical group experience, provider relations, quality improvement, claims, contracting utilization management, or clinical operations.
Project management experience at a medical group, IPA, or health plan setting.
Proficient in HEDIS/Quality measures, cost and utilization.Pay Range: $56,200.00 - $101,000.00 per year
At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
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
Skills Required
- Bachelor's degree in a 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
- Proficiency in HEDIS and quality measures
- Knowledge of cost and utilization management
- Must live in Tennessee
- Ability to travel locally four days per week
Centene Corporation Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Centene Corporation and has not been reviewed or approved by Centene Corporation.
-
Leave & Time Off Breadth — Paid holidays, vacation, personal and sick time are provided alongside paid parental and caregiver leave, with adoption reimbursement also available. Feedback suggests time-off policies are broad enough to support major life events and everyday needs.
-
Flexible Benefits — Flexible schedules, remote work options, relaxed dress codes, and an Employee Assistance Program are offered along with discounts on products and services. Feedback suggests this flexibility enhances work-life balance across varied roles and locations.
-
Retirement Support — A 401(k) retirement plan with company match and an employee stock purchase plan support long‑term financial wellbeing. Feedback suggests these programs form a stable foundation within the total rewards package.
Centene Corporation Insights
What We Do
Centene provides healthcare solutions to individuals across the United States with more than 23 million members nationwide.
