Manager, Provider Data Management

Centene Corporation•Remote-IN, IN

6d•$70,100 - $126,200•Remote

About The Position

The Manager of Provider Data Management is responsible for the end‑to‑end oversight, leadership, and operational performance of the health plan’s Provider Enrollment (including auditing), Provider Data Management, and Update processes. This role serves as the direct people leader for multiple teams operating across these functions and is accountable for provider enrollment and data accuracy, regulatory compliance, operational efficiency, and audit readiness. The position establishes and monitors Key Performance Indicators (KPIs), ensures provider enrollment and directory integrity, oversees provider enrollment provides governance over the Centene Corporate credentialing process as it applies to the health plan. This role ensures timely, accurate, and compliant provider records across all systems and public‑facing directories.

Requirements

Bachelor’s degree in related field or equivalent experience.
4+ years of contracting, provider data management, or data analytics experience.
Supervisor/lead experience preferred.

Responsibilities

Serve as the direct people leader for multiple teams responsible for Provider Enrollment, Auditing, and Provider Data Management & Updates.
Manage, coach, and develop staff through performance management, training, and career development.
Establish staffing models, productivity expectations, and cross‑functional alignment to support business and regulatory needs.
Update and maintain training materials, policies, and standard operating procedures to ensure consistent execution across teams.
Provide operational ownership and oversight of the health plan’s entire Provider Enrollment lifecycle, including initial enrollment, revalidation, updates, and terminations.
Oversee provider enrollment auditing activities to ensure compliance with state, federal, NCQA, CMS, and contractual requirements.
Provide oversight and governance of the Centene Corporate credentialing process, ensuring alignment, issue escalation, and audit readiness at the health plan level.
Partner with internal and external stakeholders to resolve enrollment, credentialing, and data discrepancies.
Ensure the timely and accurate processing of provider data updates (adds, changes, and terminations) across all systems.
Develop and maintain data integrity through audits, controls, reporting, and root‑cause analysis.
Establish and monitor KPIs and operational goals for Provider Enrollment and Provider Data Management functions.
Manage encounter response files and error correction processes related to provider data.
Lead provider data and enrollment audit preparation and execution, including internal, state, federal, and accreditation audits.
Track audit findings, corrective action plans, and ongoing monitoring activities.
Schedule and oversee monthly provider verifications related to enrollment specifications and demographic changes, particularly for designated specialty types.
Responsible for systems implementation, enhancements, and process improvements related to provider enrollment and data management.
Coordinate materials and provider data support for Requests for Applications (RFAs), new business, and expansions.
Collaborate with internal business partners to support enterprise initiatives and regulatory changes.