Program Manager II – Provider Network

🔥 0 minutes ago

🌲 Oregon – Remote

🌲 Oregon – Remote

💵 $70.1k - $126.2k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Program Manager

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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

• Conduct routine and ad hoc provider network analysis by geography, specialty, and line of business • Monitor network adequacy performance and identify potential gaps and access issues • Lead monthly and quarterly Network Adequacy Committee meetings and develop supporting reporting materials • Manage network gap remediation efforts through collaboration with Contracting, Provider Data Operations, Provider Engagement, Credentialing, Compliance, and Network Operations teams • Prepare network adequacy reporting for internal leadership and regulatory requirements • Support annual Medicaid and Medicare network adequacy exception request processes when applicable • Perform provider network impact analyses related to contract negotiations, terminations, and network strategy initiatives • Develop, maintain, and improve reporting tools, dashboards, trackers, business documentation, and process workflows • Coordinate cross-functional workgroups and ensure action items are tracked through completion • Serve as a subject matter resource for provider network composition, access, adequacy, and reporting • Perform other duties as assigned • Comply with all policies and standards

🎯 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 required • 3+ years of quality improvement, program management or project management experience required • Experience with healthcare network operations, provider contracting, network adequacy, provider data management, or managed care organizations • Strong analytical and problem-solving skills with experience interpreting large data sets and transforming findings into actionable recommendations • Advanced Excel and reporting capabilities, including pivot tables, lookups, data validation, and reporting automation • Experience working with Power BI, reporting tools, or business intelligence platforms • Strong project management and organizational skills with the ability to manage multiple priorities simultaneously • Experience facilitating meetings and leading cross-functional workgroups • Excellent written and verbal communication skills • Ability to present data and recommendations to leaders and business stakeholders • Knowledge of Medicaid, Medicare Advantage, and Commercial network requirements is highly preferred • Experience with healthcare regulatory reporting, network adequacy standards, or provider network access analysis is strongly preferred • Health care experience preferred

🏖️ 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