Program Manager II - Provider Network

Centene Corporation•Remote-OR, OR

3d•$70,100 - $126,200•Remote

About The Position

Within Centene's Oregon's Trillium Community Health Plan Provider Contracting team, this role serves as the primary business lead for provider network adequacy monitoring, reporting, and strategic network analysis across Medicaid and Medicare lines of business. This is a fully remote position. The company connects people to the care they need to live healthier lives, and the work done in this role makes that impact real every day by taking on meaningful challenges that directly support individuals, families, and communities, building skills while making healthcare more accessible and effective. It's work with a purpose that can be seen, backed by a team committed to improving lives well beyond the workday.

Requirements

Bachelor's Degree in related field or equivalent experience required.
3+ years of quality improvement, program management or project management experience required.
Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

Nice To Haves

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.

Responsibilities

Conducting routine and ad hoc provider network analysis by geography, specialty, and line of business.
Monitoring network adequacy performance and identifying potential gaps and access issues.
Leading monthly and quarterly Network Adequacy Committee (NAC) meetings and developing supporting reporting materials.
Managing network gap remediation efforts through collaboration with Contracting, Provider Data Operations, Provider Engagement, Credentialing, Compliance, and Network Operations teams.
Preparing network adequacy reporting for internal leadership and regulatory requirements.
Supporting annual Medicaid and Medicare network adequacy exception request processes when applicable.
Performing provider network impact analyses related to contract negotiations, terminations, and network strategy initiatives.
Developing, maintaining, and improving reporting tools, dashboards, trackers, business documentation, and process workflows.
Coordinating cross-functional workgroups and ensuring action items are tracked through completion.
Serving as a subject matter resource for provider network composition, access, adequacy, and reporting.
Performs other duties as assigned.
Complies with all policies and standards.