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.
Requirements
- 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.
- Conducts 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.
- Focuses 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.
- Uses data analytics to track and monitor provider performance, offering actionable feedback to help physicians optimize care delivery and meet key performance targets.
- 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.
Benefits
- Competitive pay
- Health insurance
- 401K
- Stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- Flexible work schedule with remote, hybrid, field or office work options
