Job Overview
Location
Remote-MO
Job Type
Full-time
Category
Other
Date Posted
June 3, 2026
Full Job Description
đź“‹ Description
- • Serve as the primary point of contact between Centene and contracted provider networks, acting as a liaison to ensure seamless communication and collaboration.
- • Triage and resolve provider-related issues by coordinating with internal teams to deliver timely and accurate solutions.
- • Receive, investigate, and respond to external provider concerns, including claim disputes, policy clarifications, and operational challenges.
- • Initiate and maintain accurate data entry for provider demographic and contractual information changes within internal systems.
- • Educate providers on health plan policies and procedures related to referrals, claims submission, website utilization, and EDI processes.
- • Conduct provider orientations and deliver ongoing education sessions, including developing and updating training materials and resources.
- • Manage network performance for assigned geographic territory using a consultative account management approach to drive operational excellence.
- • Evaluate provider performance metrics across key areas including Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality measures, cost, and utilization.
- • Develop and implement strategic action plans to improve provider performance and align with contract incentive goals.
- • Complete special projects as assigned by leadership to support network optimization, compliance, or operational initiatives.
- • Travel locally up to four days per week to conduct in-person provider meetings, site visits, and relationship-building activities.
- • Ensure full compliance with all company policies, regulatory standards, and operational protocols.
- • Perform additional duties as assigned to support the broader goals of provider engagement and network integrity.
🎯 Requirements
- • Bachelor’s degree in a related field or equivalent experience
- • Two years of experience in managed care, medical group operations, provider relations, quality improvement, claims, contracting, utilization management, or clinical operations
- • Proven project management experience in a medical group, IPA, or health plan setting
- • Proficiency in HEDIS/Quality measures, cost analysis, and utilization metrics
- • Ability to travel locally up to four days per week
- • Strong communication and interpersonal skills for provider engagement and education
🏖️ Benefits
- • Competitive pay ranging from $56,200 to $101,000 per year
- • Comprehensive health insurance coverage
- • 401(k) and stock purchase plans
- • Tuition reimbursement
- • Paid time off and holidays
- • Flexible work arrangements including remote, hybrid, field, or office options
Skills & Technologies
About Centene Corporation
Centene Corporation is a publicly traded managed-care enterprise that arranges health-benefit programs for government-sponsored and privately insured individuals. Operating across all 50 U.S. states and internationally, the company focuses on under-insured and uninsured populations through Medicaid, Medicare, and Marketplace offerings. Its services include behavioral health, pharmacy benefits, vision, dental, telehealth, and in-house clinical programs. Centene partners with physicians, hospitals, and community organizations to coordinate cost-effective care, emphasizing data analytics and value-based reimbursement models. Headquartered in St. Louis, Missouri, it serves more than 25 million members, positioning itself as a leading intermediary between payers and healthcare providers.
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