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Manager, Provider Network

Smyrna, Georgia Apply Now Job ID 1154109 Category Network Development & Contracting Organization Peach State Health Plan Schedule Full-time
Description:

Position Purpose: Manages the day-to-day operations of the network accounts department

  • Develop, implement and monitor quality initiatives to achieve healthy outcomes for assigned projects
  • Provide guidance in the resolution of complex claims payment and provider systems set-up issues
  • Oversee the planning of health plan-sponsored events act as host at such events for network account representatives
  • Develop and recommend updates to policies and procedures and ensure Provider Manuals are accurate and up-to-date
  • Manage the day-to-day workflow of the network accounts function in compliance with health plan, corporate and state policies, procedures and guidelines
  • Participate in provider contracting activities to minimize contract implementation issues/errors
  • Receive and respond to all urgent and emergent provider issues
  • Ensure standards are established, met and maintained
  • Plan, coordinate and participate in scheduled and unscheduled meetings with network account representatives to conduct orientations, train on health plan policies and procedures, deliver materials or inquire about contracting with our health plan
  • Review and audit network accounts documentation for compliance with health plan and State standards
  •  Some travel included
    • Manage the network accounts team to ensure goals and objectives are met through effective hiring, performance management, training, coaching and career development

  • Qualifications:

    Education/Experience:


    • Bachelor’s degree in related field or equivalent experience.
    • 4+ years of network account management or provider contracting experience in a managed care environment.
    • Supervisory or lead experience preferred.
    • Knowledge of managed care and state Medicaid program guidelines
    • Proficiency in Microsoft Office products
    • CMO experience a plus

      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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