Senior Manager, Credentialing & Provider Data Analytics

Centene Corporation • St. David's, MI

8d • $87,700 - $157,800

About The Position

The Senior Manager of Credentialing and Provider Data Management oversees the full credentialing and provider-data-entry process, from triage through provider enrollment and data maintenance. The role leads a team supporting the credentialing and provider data management organization from a technical perspective, including system updates and enhancements, data analysis, and reporting.

The position has direct oversight of credentialing and re-credentialing for physicians, mid-level practitioners, and organizational providers. It also oversees provider-data management activities, including training materials, policies, and procedures, and ensures provider records and directories are accurate and compliant with applicable health plan policies, performance indicators, NCQA standards, and state and federal requirements.

Applicants must be authorized to work in the United States without current or future employment-based visa sponsorship. The position offers a stated annual pay range of $87,700 to $157,800. Centene describes its work as supporting access to healthcare and improving outcomes for individuals, families, and communities.

Requirements

• Bachelor’s degree or equivalent experience.
• At least 4 years of relevant experience.
• Knowledge of NCQA, credentialing, and provider data management.
• At least 3 years of supervisory or management experience.
• Authorization to work in the United States without the need for current or future employment-based visa sponsorship.

Nice To Haves

• Strong technical background.
• Experience leading technical teams.
• Hands-on expertise with SQL Server.
• Knowledge of managed care operations.
• Experience with Portico, Amisys, or CenProv.

Responsibilities

• Lead a team providing technical support to the credentialing and provider data management organization, including system updates and enhancements, data analysis, and reporting.
• Directly oversee credentialing and re-credentialing for physicians, mid-level practitioners, and organizational providers.
• Oversee provider data management activities, including developing and managing training materials, policies, and procedures.
• Ensure additions, changes, and terminations to new or existing provider records comply with health plan policies and state and federal regulations.
• Ensure compliance with corporate key performance indicators, NCQA credentialing standards, and state and federal requirements.
• Manage updates to and production of hard-copy and online provider directories.
• Ensure the accuracy of provider enrollment specifications, specialty types, and demographics.

Benefits

• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off and holidays
• Flexible approach to work schedules, including remote, hybrid, field, or office arrangements
• Competitive pay

What This Job Offers

• Job Type: Full-time
• Career Level: Senior