Senior Manager, Credentialing & Provider Data Management

Job not on LinkedIn

🔥 22 hours ago

🌵 Arizona, Kentucky, +2 more states – Remote

🌵 Arizona – Remote 🐎 Kentucky – Remote 🔔 Pennsylvania – Remote 🎸 Tennessee – Remote

💵 $87.7k - $157.8k / year

⏰ Full Time

🟠 Senior

📊 Data Scientist

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

⚕️ Healthcare Insurance

🤝 Non-profit

🌍 Social Impact

Healthcare Insurance • Non-profit • Social Impact

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Oversee all direct processes of credentialing and provider data entry, from triage through provider enrollment and data maintenance • Direct oversight for credentialing and re-credentialing of all physicians, mid-level practitioners and organizational providers • Oversee all activities related to the management of provider data, including the development and management of training materials, policies, and procedures • Ensure updates (adds, changes, and terminations) for new or existing provider records are made in accordance with health plan policies and state/federal regulations • Ensure compliance with key performance indicators established by corporate office, NCQA credentialing standards, and state/federal requirements • Manage updates to and production of hard copy and online provider directories • Ensure accuracy of provider enrollment specifications and specialty types and demographics

🎯 Requirements

• Bachelor’s degree or equivalent experience • 4 years of relevant experience • NCQA, credentialing, and provider data management knowledge required • 3+ years of supervisory/management experience • Preferred experience with Portico, Amisys, CenProv

🏖️ Benefits

• competitive pay • health insurance • 401K and stock purchase plans • tuition reimbursement • paid time off plus holidays • flexible approach to work with remote, hybrid, field or office work schedules