Manager, Provider Data Management – Credentialing

🔥 12 hours ago

🌵 Arizona, Florida, +4 more states – Remote

🌵 Arizona – Remote 🐊 Florida – Remote 🌲 North Carolina – Remote 🚗 Michigan – Remote 🏰 Missouri – Remote 🤠 Texas – Remote

💵 $87.7k - $157.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 0%

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

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

• Manage operations of credentialing and provider data management functions for multiple business units • Oversee credentialing and re-credentialing of physicians, mid-level practitioners and organizational providers • Oversee provider setup processes for claims payment, member assignment and directory display • Ensure compliance with NCQA and DHHS credentialing requirements • Participate in activities related to plan NCQA accreditation • Collaborate with health plans and departments on network expansion, large claims, contract amendment projects and related initiatives • Identify process improvement opportunities to decrease cost, improve quality and increase efficiency • Review and update departmental policies and procedures for compliance with NCQA, CMS and other regulatory agencies • Monitor Medicaid and Medicare sanctioning reports for compliance with HCFA requirements • Facilitate Credentialing Committee activities • Serve on Quality Improvement Committees when needed

🎯 Requirements

• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future • Bachelor’s degree in related field or equivalent experience • 5+ years of combined management and provider data management, credentialing or healthcare operations experience • Experience preferably in a managed care or insurance environment • Previous experience as a lead in a functional area, managing cross functional teams on large scale projects, or supervisory experience • Supervisory experience including hiring, training, assigning work and managing staff performance • Knowledge of NCQA, DHHS, CMS and other regulatory standards • Experience with physician, mid-level practitioner and organizational provider credentialing and re-credentialing • Experience with provider setup processes for claims payment, member assignment and directory display • Experience monitoring Medicaid and Medicare sanctioning reports and HCFA requirements

🏖️ Benefits

• Competitive pay • Health insurance • 401K • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation • Equal opportunity employer committed to diversity