Centene Corporation

Compensation

Full Description

Job Description: • Develop strategic partnerships between the health plan and the contracted provider networks serving our communities • Cultivate client relations and collaborate with providers to ensure delivery of the highest level of care to our members • Participate in the development of network management strategies • Creates strategic initiatives for performance improvement • Serve as a strategic partner/primary contact for hospital systems, multi-specialty groups, and large PCP groups with Value Based/Risk Components • Executes provider performance improvement strategies in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc • Builds strong interpersonal relationships with cross functional teams both externally (provider) and internally (health plan)-C-suite Level • Expert proficiency in tools and value-based performance (VBP) in order to educate providers resulting in improved provider performance • Resolves provider issues as needed for resolution to internal partners and creating efficiencies to prevent continued concerns • Receive and effectively respond to external provider related issues • Investigate, resolve and communicate provider high dollar and high volume provider claim issues and changes • Educate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics • Evaluates provider performance and develops strategic plan to improve performance • Present detailed HBR analysis and create reports for Joint Operating Committee meetings (JOC) • Acts as a lead for the external representatives • Coaches and trains external representatives • Ability to travel locally 4 days a week • Performs other duties as assigned • Complies with all policies and standards Requirements: • Bachelor’s degree in related field or equivalent experience • Master’s Degree preferred in Public Health (MOH), Health Administration (MHA) or Business Administration (MBA) • Five or more years of managed care or medical group experience, provider relations, quality improvement, utilization management, or clinical operations • Project management experience at a medical group, IPA, or health plan setting • Executive level exposure and ability to influence desired outcomes, innovation, performance, member improvements, growth and Provider retention • Ability to synthesize complex issues at multiple organizational levels, externally and internally across multi-disciplinary teams • Highly proficient in HEDIS/Quality measures, cost and utilization. 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