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.
***NOTE: Candidates must be available to work during PST business hours***
Position Purpose: 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 effeciencies to prevent continued concerns
- Receive and effectively respond to external provider related issues
- Educate provider partners 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 25% with occasional overnight
- Performs other duties as assigned
- Complies with all policies and standards
- Direct Provider Engagement: 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.
- Value-Based Care Model: 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.
- Performance Management: Uses data analytics to track and monitor provider performance, offering actionable feedback to help physicians optimize care delivery and meet key performance targets.
Education/Experience: 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.
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
