Senior Regional Provider Engagement Manager

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
 

***Candidate must reside in Chicago IL or surrounding areas. Role will require both in office presence as well as travel throughout the region.  Highly preferred that candidate possess experience in the following areas:

·        Train on Provider Performance: Equip market associates with the knowledge and tools to improve Medical Expense Ratio, Risk Adjustment accuracy, and overall financial outcomes.

·        Guide Effective JOCs: Teach teams how to plan, execute, and leverage Joint Operations Committee meetings to align providers and internal teams on performance goals.

·        Develop Data Proficiency: Train associates to interpret and act on financial and quality metrics (e.g., HEDIS, STARs) to drive targeted improvement strategies.

·        Coach on Engagement Strategies: Educate market teams on building strong provider relationships, optimizing incentive programs, and implementing value-based care models.***

Position Purpose:
The Regional Provider Engagement Manager plays a critical role in driving provider performance and engagement efforts across a specific region encompassing multiple local markets. This role will serve as a strategic leader driving provider performance improvement strategies, whiled aligning engagement efforts with enterprise goals for quality, coding, cost, and utilization. This role will also act as a trusted advisor to market leadership and serve as a key influencer in provider engagement initiatives.

• Provide hands-on Provider Engagement Operating Model (PEOM) support and guidance focused on coaching market teams to lead effective, data-driven provider performance conversations, including in-person performance enablement sessions, new hire performance immersion, and rollout of performance-focused initiatives and reporting.
• Engage in Monthly and Quarterly PE Regional Leadership check-ins to review provider performance trends, prioritize high-impact provider groups, and align on corrective and growth strategies.
• Lead new Provider Engagement implementations within assigned regions with an emphasis on performance measurement, standardized performance templates, reporting, and accountability frameworks.
• Drive execution of key strategic initiatives that improve provider quality, cost performance, risk adjustment accuracy, pharmacy performance, and value-based outcomes across local markets.
• Support development and execution of strategic operational plans tied directly to provider performance improvement, including large-scale performance transformation initiatives.
• Collaborate with health plan leaders to support system-wide implementations that enable provider performance improvement, ensuring learnings transition from pilot to full-scale execution.
• Drive and interpret provider performance KPIs, including quality, medical expense ratio (MER/HBR), risk adjustment, pharmacy measures, and value-based performance outcomes.
• Utilize data analysis to identify provider performance gaps and develop targeted, measurable action plans to improve outcomes.
• Support local market relationships by leading structured, outcome-oriented provider performance engagement with high-impact providers rather than routine provider servicing or issue resolution.
• Partner with health plans and the enterprise Provider Experience team to monitor and improve provider performance in risk-based arrangements across multiple product lines.
• Assist in driving provider-related corporate initiatives, strategies, and goals that advance enterprise-wide provider performance and value-based care objectives.
• Analyze industry trends, provider performance models, and emerging technologies to enhance provider engagement strategies and performance outcomes.
• Analyze and interpret provider performance data using research methods to inform strategic recommendations and provider action plans.
• Prepare and deliver actionable performance insights through dashboards, presentations, and reports that directly support provider and market-level decision-making.
• Escalate systemic performance barriers and risks that impede provider outcomes to ensure timely resolution and sustained performance improvement.
• Enhance and leverage analytics, member demographics, and utilization patterns to identify provider efficiency opportunities and care delivery improvements.
• Collaborate with operational teams and vendors to address structural or process-related barriers impacting provider performance—not to manage routine claims or provider inquiries.
• Perform special projects as assigned or directed..
• Complies with all policies and standards.

Education/Experience:

Bachelor's Degree health care administration, business, or related field or equivalent experience required

Master's Degree health care administration, business, or related field preferred

6+ years In provider engagement, network management, or healthcare strategy. required

In-depth knowledge of provider engagement, network management, and performance improvement methodologies required required

Demonstrated track record of successfully leading cross-functional provider engagement teams and driving results in a dynamic environment required

Proven ability to influence senior leaders and manage complex initiatives. required

Strong analytical skills with proficiency in interpreting performance metrics (HEDIS, STARs, risk adjustment, cost/utilization) required

Role requires roughly 50% local travel; mileage reimbursement will be issued.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act