Centene Corporation

Compensation

Full Description

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description This role involves maintaining partnerships between the health plan and the contracted provider networks serving our communities. • Build client relations to ensure delivery of the highest level of care to our members. • Engage with providers to align on network performance opportunities and solutions. • Consultative account management and accountability for issue resolution. • Drive optimal performance in contract incentive performance, quality, and cost utilization. • Serve as primary contact for providers and act as a liaison between the providers and the health plan. • Triages provider issues as needed for resolution to internal partners. • Receive and effectively respond to external provider related issues. • Investigate, resolve and communicate provider claim issues and changes. • Initiate data entry of provider-related demographic information changes. • Educate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics. • Perform provider orientations and ongoing provider education, including writing and updating orientation materials. • Manage Network performance for assigned territory through a consultative/account management approach. • Evaluate provider performance and develop strategic plan to improve performance. • Drive provider performance improvement in areas such as Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization. • Complete special projects as assigned. • Ability to travel 25%. • Perform other duties as assigned. • Comply with all policies and standards. • Conduct regular in-person visits with physicians to provide real-time support, discuss performance metrics, and identify opportunities for improvement in patient care and clinical practices. • Focus on value-based care model initiatives, collaborating with physicians to identify and align to performance-based agreements that incentivize better patient outcomes, cost-efficiency, and quality care. • Use data analytics to track and monitor provider performance, offering actionable feedback to help physicians optimize care delivery and meet key performance targets. Qualifications • Bachelor’s degree in related field or equivalent experience. • Two years of managed care or medical group experience, provider relations, quality improvement, claims, contracting utilization management, or clinical operations. • Project management experience at a medical group, IPA, or health plan setting. • Proficient in HEDIS/Quality measures, cost and utilization. Requirements • Ability to travel 25%. Benefits • Competitive pay. • Health insurance. • 401K and stock purchase plans. • Tuition reimbursement. • Paid time off plus holidays. • Flexible approach to work with remote, hybrid, field or office work schedules.