Note: The job is a remote job and is open to candidates in USA. Centene Corporation is hiring a Senior Manager to oversee credentialing and provider data management processes, from triage through provider enrollment and data maintenance. The role leads technical support for the organization, including system enhancements, data analysis, reporting, and oversight of provider records and directories.
Responsibilities
- The Senior Manager of Credentialing and PDM will oversee all direct processes of credentialing and provider data entry, from triage through provider enrollment and data maintenance
- This role will focus on leading a team that supports the credentialing and provider data management organization from a technical perspective including system updates and enhancements, data analysis, and reporting
- 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
Skills
- 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 required
- 3+ years of supervisory/management experience
- A strong technical background
- Experience leading technical teams
- Hands-on expertise with SQL Server
- Knowledge of provider data management (PDM), credentialing, and managed care operations
- Preferred experience with Portico, Amisys, CenProv
Benefits
- Health insurance
- 401K and stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- A flexible approach to work with remote, hybrid, field or office work schedules
Company Overview