Manager, Provider Data Management

🕒 July 22

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $70.1k - $126.2k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 23%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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

• Lead inventory, quality, production, and employee development within the Illinois Health Plan • Manage provider data management projects, policies, procedures, and provider contract setup activities • Support provider data maintenance, claims adjudication, directory accuracy, and other operational projects • Partner with Credentialing to set up and maintain delegated entity arrangements • Oversee development of reports supporting strategic and operational departmental requirements • Identify and implement value-added programs and initiatives supporting network contracting and operational efficiency • Serve as main contact for internal departments on provider, contract, and claims application changes • Meet with internal departments to identify project requirements and ensure satisfactory completion • Work with the Information Systems Department on special projects • Supervise staff and direct and monitor staff activity • Conduct reviews and one-on-ones, and provide monthly performance statistics • Monitor quality scores, production scores, and production turnaround times • Maintain working knowledge of provider data management, provider reimbursement, and claims processing applications • Develop cost-benefit analyses for project prioritization and justification • Develop and update policies, procedures, manuals, and training with internal departments • Lead meetings about new workflows, policies, and procedures • Conduct training for internal and external departments on provider data services policies and procedures • Resolve issues related to contract or policy interpretation • Define reporting and information initiatives with internal and external customers • Perform ad-hoc reporting and prioritize data analysis projects • Maintain provider data integrity guidelines for delegated credentialing vendors • Design and develop workflows, protocols, and process models for standard and ad-hoc reports • Maintain, test, and revise data analysis programs • Manage input data from internal and external sources • Comply with all policies and standards and perform other duties as assigned

🎯 Requirements

• Bachelor’s degree required in business administration, Health Care, or a related field • 1-3 years management experience in a business setting required • Minimum 3 years’ experience working in a health care setting • Preferably background in provider relations, provider data services, information technology or claims operations • Experience developing new business processes and procedures • Strong history of leadership roles with direct reports • Proficient in Microsoft Office Suite, especially Excel, Visio, and Word • Good communication and meeting facilitation skills • Knowledge and experience working with Portico, Amisys, Directory, and other provider-related systems • Must be authorized to work in the U.S. without employment-based visa sponsorship now or in the future • Must be available for Central time (CST) working hours • 10% travel requirement

🏖️ Benefits

• Competitive pay • Health insurance • 401K plan • 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