Senior Manager, Provider Network Management Operations
Centene Corporation
full-time
Posted on:
Location Type: Remote
Location: California • Idaho • United States
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Salary
💰 $107,700 - $199,300 per year
Job Level
About the role
- Oversee network management activities including network development, provider relations, and provider data analytics within an assigned market.
- Develop, implement, evaluate, and improve operational models aligned with strategic initiatives and compliant with accreditation, legislative and regulatory requirements.
- Responsible for overseeing the development of reports to support quality member outcomes, provider recruitment, provider retention, and contracting initiatives.
- Develop and drive uniformity, efficiencies and consistencies within Provider Network Management promoting Manage daily activities of staff, including network development, provider relations, and provider data analytics.
- Oversee quality assurance processes and reporting to ensure compliance with accreditation, federal and state regulatory requirements including access and availability and demographic reporting related to providers.
- Establish and maintain strong relationships with other divisions to ensure that provider network management activities are linked appropriately to other applicable areas of the organization.
- Implement and manage development of documented provider network management policies and procedures.
- Oversee quality audits and compliance reporting across all areas of provider network management.
- Develop education and communication plans for internal staff and providers.
- Facilitate and assist with problem resolution for internal provider network management issues but also for broader scope issues that impact provider network management including but not limited to providers, claims, customer contact center, medical management, and appeals and grievances.
- Perform management duties including budgeting, performance management, staff development, training, staffing, and establishing department goals and objectives.
Requirements
- Strong leadership experience
- Experience with claims data and roster management
- Understanding of health plan operations
- Experience in network development, provider relations, and provider network management
- Bachelor’s Degree in Business, Healthcare, or related field or equivalent experience
- 5+ years of combined health plan operations, network development, provider relations, or contracting experience
- In depth knowledge of compliance and access and availability requirements.
- Experience with compliance reporting and analyzing data.
- Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.
Benefits
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work with remote, hybrid, field or office work schedules
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
network managementprovider data analyticsoperational modelsquality assurance processescompliance reportingclaims data managementroster managementprovider network managementbudgetingperformance management
Soft Skills
leadershiprelationship buildingproblem resolutionstaff developmenttrainingcommunicationorganizational skillsstrategic thinkingcollaborationgoal setting
Certifications
Bachelor’s Degree in BusinessBachelor’s Degree in Healthcarerelated field or equivalent experience