Centene Corporation Director, Provider Data Management in Town and Country, Missouri

ProfessionalPosition Purpose: Oversee the all provider data management activities for multiple business units, including inventory management, quality and service level agreements for turnaround times, and system maintenance and enhancements.

  • Oversee all provider data management activities ensuring provider data quality and system application stability to meet business requirements

  • Oversee complex projects and programs from design to development to execution for systems enhancement and development based on updates in requirements or process improvements

  • Oversee the provider setup processes ensuring accurate and timely setup for claims payment, member assignment and directory display

  • Ensure compliance with NCQA and DHHS credentialing requirements and participate in activities related to plan NCQA accreditation

  • Collaborate with the health plans and various departments on network expansion efforts, large claims and contract amendment projects and various related initiatives

  • Identify process improvement opportunities to decrease cost, improve quality and increase efficiency within the department

  • Oversee the development of policies and procedures, work processes, standard operating procedures and other tools to standardize provider data management processes across the enterprise and ensure compliance with NCQA, CMS and other regulatory agencies

  • Assist other non-corporate managed markets with inventory backlog during product or product expansions and process improvement challenges

Education/Experience: Bachelor's degree in Business, Healthcare Administration, related field, or equivalent experience. 7+ years of combined project management, business analysis and process improvement experience, preferably in the healthcare, managed care, or government programs industry. Experience in a management role, including responsibility for hiring, training, assigning work, and performance management of direct reports. Provider data management and/or contracting experience preferred.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

TITLE: Director, Provider Data Management

LOCATION: Town and Country, Missouri

REQNUMBER: 1116249

COMPANY: Provider Data Management, Leadership

POSITION TYPE: Professional