Senior Manager, Credentialing – Provider Data Management Systems

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🔥 0 minutes ago

🌵 Arizona, Florida, +6 more states – Remote

🌵 Arizona – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🌲 North Carolina – Remote 🚗 Michigan – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote 🤠 Texas – Remote

💵 $87.7k - $157.8k / year

⏰ Full Time

🟠 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

• Oversee all direct processes of credentialing and provider data entry, from triage through provider enrollment and data maintenance • Lead a team supporting the credentialing and provider data management organization from a technical perspective • Manage system updates and enhancements, data analysis, and reporting • Provide direct oversight for credentialing and re-credentialing of physicians, mid-level practitioners, and organizational providers • Oversee provider data management activities, including training materials, policies, and procedures • Ensure provider record updates comply with health plan policies and state/federal regulations • Ensure compliance with corporate KPIs, NCQA credentialing standards, and state/federal requirements • Manage production and updates of hard copy and online provider directories • Ensure accuracy of provider enrollment specifications, specialty types, and demographics

🎯 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 or equivalent experience • 4 years of relevant experience • NCQA, credentialing, and provider data management knowledge • 3+ years of supervisory/management experience • Preferred: strong technical background • Preferred: experience leading technical teams • Preferred: hands-on expertise with SQL Server • Preferred: knowledge of provider data management (PDM), credentialing, and managed care operations • Preferred experience with Portico, Amisys, CenProv

🏖️ Benefits

• Competitive pay • Health insurance • 401K plan • Stock purchase plan • 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