Manager, Provider Data Management

Description

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.

The Manager of Provider Data Management is responsible for the end‑to‑end oversight, leadership, and operational performance of the health plan’s Provider Enrollment (including auditing), Provider Data Management, and Update processes. This role serves as the direct people leader for multiple teams operating across these functions and is accountable for provider enrollment and data accuracy, regulatory compliance, operational efficiency, and audit readiness.

The position establishes and monitors Key Performance Indicators (KPIs), ensures provider enrollment and directory integrity, oversees provider enrollment provides governance over the Centene Corporate credentialing process as it applies to the health plan. This role ensures timely, accurate, and compliant provider records across all systems and public‑facing directories.

Essential Functions & Responsibilities

• Serve as the direct people leader for multiple teams responsible for Provider Enrollment, Auditing, and Provider Data Management & Updates.
• Manage, coach, and develop staff through performance management, training, and career development.
• Establish staffing models, productivity expectations, and cross‑functional alignment to support business and regulatory needs.
• Update and maintain training materials, policies, and standard operating procedures to ensure consistent execution across teams.
• Provide operational ownership and oversight of the health plan’s entire Provider Enrollment lifecycle, including initial enrollment, revalidation, updates, and terminations.
• Oversee provider enrollment auditing activities to ensure compliance with state, federal, NCQA, CMS, and contractual requirements.
• Provide oversight and governance of the Centene Corporate credentialing process, ensuring alignment, issue escalation, and audit readiness at the health plan level.
• Partner with internal and external stakeholders to resolve enrollment, credentialing, and data discrepancies.
• Ensure the timely and accurate processing of provider data updates (adds, changes, and terminations) across all systems.
• Develop and maintain data integrity through audits, controls, reporting, and root‑cause analysis.
• Establish and monitor KPIs and operational goals for Provider Enrollment and Provider Data Management functions.
• Manage encounter response files and error correction processes related to provider data.
• Lead provider data and enrollment audit preparation and execution, including internal, state, federal, and accreditation audits.
• Track audit findings, corrective action plans, and ongoing monitoring activities.
• Schedule and oversee monthly provider verifications related to enrollment specifications and demographic changes, particularly for designated specialty types.
• Responsible for systems implementation, enhancements, and process improvements related to provider enrollment and data management.
• Coordinate materials and provider data support for Requests for Applications (RFAs), new business, and expansions.
• Collaborate with internal business partners to support enterprise initiatives and regulatory changes

Education/Experience: Bachelor’s degree in related field or equivalent experience. 4+ years of contracting, provider data management, or data analytics experience. Supervisor/lead experience preferred.

This position is 100% remote within the United States.

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