Manager Member & Provider Services

Centene Corporation is a leading multi-line healthcare enterprise that provides managed-care programs and related services to individuals receiving benefits under Medicaid, including Supplemental Security Income (SSI) and the State Children’s Health Insurance Program (SCHIP).POSITION PURPOSE: Perform duties to manage the day-to-day work function of the member and provider services area, provide support to staff and investigate and resolve complex member or provider issues.POSITION QUALIFICATION REQUIREMENTS: Knowledge/Experience: Thorough knowledge of the customer service and provider service functions in a managed care environment and medical terminology and coding involving a thorough skills knowledge plus the application of basic theory. Equivalent to four (4) year college education. Over 2 years up to and including 4 years of member service and provider service experience, preferably in a Medicaid managed care or insurance environment. Over 1 year up to and including 3 years of supervisory experience.Skills/Competencies: Apply principles of logical or scientific thinking to define problems, collect data, establish facts, and draw valid conclusions. Deal with several abstract and concrete variables. Ability to supervise others: determining or interpreting work procedures for a group of workers, assigning specific duties to them, maintaining harmonious relations among them, and promoting efficiency. Deal with system of real numbers; related algebraic solution of equations and inequalities; limits and continuity; and probability and statistical inference. Practical application of fractions, percentages, ratio and proportion, practical algebra, and geometric construction. Perform reading, writing and speaking at an advanced level, demonstrating good oral and written communication skills, as well as attention to details. Ability to use computer systems for the management, reporting and presentation of information, as well as correspondence. Ability to travel.CRITICAL JOB ELEMENTS: Normal office work environment. Dexterity of hands and fingers and little physical effort. Normal mental effort, including timeliness of decision making, memory, and analytical thinking. Excellent verbal and non-verbal communications skills. Ability to hear and speak. PRINCIPAL FUNCTIONS & ACCOUNTABILITIES: Strategic Planning: Drives change initiatives to address future-oriented business needs. Identifies process and infrastructures needed to support change and considers broad range of internal/external factors when making decisions. Translates trends and patterns into long term initiatives. Takes business action based on impact and responds to issues that require management intervention, and insure that all functions of the provider and member service departments meet or exceed department/plan and overall corporate expectations.People Management: Consistently thinks and acts as a business leader. Sets challenging and far reaching standards. Drives for measurable results and success within the member and provider service departments.People Development & Succession: Develop leadership capacity in others. Provide frequent feedback, coaching, and development opportunities to member and provider services staff.Fiduciary Responsibility: Oversee the day-to-day workflow of the provider and member services departments within the guidelines of the annual budget.Annual Budgeting: Assist in development of annual budget for member and provider services departments.Leadership: Directly supervise the member and provider services supervisors and staff. Develop policies, procedures and performance standards for the member and provider services departments in compliance with Federal, State and Company regulations, and in conjunction with site management and appropriate corporate staff.Attendance: Punctuality and regular attendance required including working extra hours.4 or more years of expericence