Provider Engagement Specialist II

8 hours ago


Harrisburg, Pennsylvania, United States Centene Corporation Full time
Job Title: Provider Engagement Administrator II

Centene Corporation is seeking a highly skilled Provider Engagement Administrator II to join our team. As a key member of our organization, you will play a critical role in building and maintaining strong relationships with healthcare providers, driving network performance improvement, and ensuring seamless communication between providers and our health plan.

Key Responsibilities:
  • Act as a liaison between Tier II providers and the health plan, managing network performance for assigned territory through a consultative/account management approach.
  • Drive provider performance improvement in areas such as risk/P4Q, health benefit ratio (HBR), HEDIS/quality, cost, and utilization.
  • Evaluate provider performance and develop strategic plans to improve performance.
  • Perform detailed HBR analysis and create reports for Joint Operating Committee meetings (JOC).
  • Develop proficiency in tools and value-based performance (VBP) and educate providers on use of tools and interpretation of data.
  • Coach new and less experienced External Reps.
  • Complete special projects as assigned.
Requirements:
  • Bachelor's degree in related field or equivalent experience.
  • Three years of provider relations, provider claims/reimbursement, or contracting experience.
  • Knowledge of healthcare, managed care, Medicare, or Medicaid.
What We Offer:
  • Competitive pay.
  • Health insurance.
  • 401K and stock purchase plans.
  • Tuition reimbursement.
  • Paid time off plus holidays.
  • A flexible approach to work with remote, hybrid, field, or office work schedules.


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