Senior Manager, Provider Network Management 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.
Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.
• *This position is fully remote. Oregon residency is preferred due to travel requirements of up to 50% for provider and office visits.
Qualified candidates must have:
• 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
Position Purpose: 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
Education/Experience: 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.Pay Range: $107,700.00 - $199,300.00 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, 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
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Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.
• *This position is fully remote. Oregon residency is preferred due to travel requirements of up to 50% for provider and office visits.
Qualified candidates must have:
• 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
Position Purpose: 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
Education/Experience: 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.Pay Range: $107,700.00 - $199,300.00 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, 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
Apply Now
Apply Now