Manager, Provider Relations Job at Pennsylvania Health & Wellness
You could be the one who changes everything for our 26 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.
Position Purpose: Responsible for maintaining existing and developing new provider relations, and assisting with contracting activities
Responsible for maintaining existing and developing new provider relations, and assisting with contracting activities.
Manage the staff in Provider Relations area including work flow, training and communication standards
Manage day-to-day provider relations activities and provider relations department
Develop, implement and maintain production and quality standards for the Provider Relations staff
Monitor and analyze costs and prepare departmental budget
Coordinate all post-contract activities with providers such as, site visits, training, orientation to contractual requirements, etc.
Prepare and analyze information to evaluate the performance of health plan providers
Manage and coordinate customized provider contracts and hospital contracts
Participate in physician and ancillary provider relations in foreign state markets through implementation and startup phases
Assist in the development and management of governance and utilization of strategies related to provider performance management, engagement, and communication.
The role is responsible for developing and implementing efficient provider satisfaction, performance improvement and delivery system strategies through innovation and industry leadership with a focus on anticipating and responding to market needs. This position works closely with internal and external leaders, providers, associations and other institutions to drive performance in engagement models resulting in higher quality and lower costs resulting in optimizing provider incentives.
50% Remote, 40% field based travel (PA territory), and 10% travel for in office meetings at the Corporate/Central Office location in Camp Hill, PA.
Preferred knowledge of HEDIS, Medicare STARs, CAHPs, pay for performance, access and availability.
Knowledge of Center for Medicare/Medicaid Services, requirements for Special Needs Plans (SNP), Medicare Medicaid Plans (MMP) and NCQA oversight requirements highly preferred.
Education/Experience: Bachelor’s degree in related field or equivalent experience. 4+ years of managed care, health delivery system and/or project and staff management experience. Experience with state and federal health programs such as Medicaid and Medicare. Provider relations/contracting experience including solid communication and negotiation skills. Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
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.
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Position Purpose: Responsible for maintaining existing and developing new provider relations, and assisting with contracting activities
Responsible for maintaining existing and developing new provider relations, and assisting with contracting activities.
Manage the staff in Provider Relations area including work flow, training and communication standards
Manage day-to-day provider relations activities and provider relations department
Develop, implement and maintain production and quality standards for the Provider Relations staff
Monitor and analyze costs and prepare departmental budget
Coordinate all post-contract activities with providers such as, site visits, training, orientation to contractual requirements, etc.
Prepare and analyze information to evaluate the performance of health plan providers
Manage and coordinate customized provider contracts and hospital contracts
Participate in physician and ancillary provider relations in foreign state markets through implementation and startup phases
Assist in the development and management of governance and utilization of strategies related to provider performance management, engagement, and communication.
The role is responsible for developing and implementing efficient provider satisfaction, performance improvement and delivery system strategies through innovation and industry leadership with a focus on anticipating and responding to market needs. This position works closely with internal and external leaders, providers, associations and other institutions to drive performance in engagement models resulting in higher quality and lower costs resulting in optimizing provider incentives.
50% Remote, 40% field based travel (PA territory), and 10% travel for in office meetings at the Corporate/Central Office location in Camp Hill, PA.
Preferred knowledge of HEDIS, Medicare STARs, CAHPs, pay for performance, access and availability.
Knowledge of Center for Medicare/Medicaid Services, requirements for Special Needs Plans (SNP), Medicare Medicaid Plans (MMP) and NCQA oversight requirements highly preferred.
Education/Experience: Bachelor’s degree in related field or equivalent experience. 4+ years of managed care, health delivery system and/or project and staff management experience. Experience with state and federal health programs such as Medicaid and Medicare. Provider relations/contracting experience including solid communication and negotiation skills. Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
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.
Please Note :
epokagency.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, epokagency.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, Site.com is the ideal place to find your next job.