Centene Corporation
Highly preferred candidate resides in Oregon (Eugene, Portland, or surrounding areas) and is willing to travel locally.
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.
Responsibilities
Serve as a strategic partner/primary contact for hospital systems, multi‑specialty groups, and large PCP groups with Value Based/Risk components.
Execute provider performance improvement strategies in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc.
Build 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) to educate providers resulting in improved provider performance.
Resolve provider issues as needed for resolution to internal partners and create efficiencies to prevent continued concerns.
Receive and respond effectively to external provider‑related issues.
Investigate, resolve, and communicate provider high‑dollar and high‑volume claim issues and changes.
Educate providers regarding policies and procedures related to referrals, claim submission, web‑site usage, EDI solicitation and related topics.
Evaluate provider performance and develop a strategic plan to improve performance.
Present detailed HBR analysis and create reports for Joint Operating Committee (JOC) meetings.
Act as a lead for external representatives.
Coach and train external representatives.
Travel locally 4 days a week.
Perform other duties as assigned.
Comply with all policies and standards.
Education & Experience Bachelor’s degree in a related field or equivalent experience. 5+ years of managed care or medical group experience in provider relations, quality improvement, utilization management, or clinical operations. Project management experience in a medical group, IPA, or health plan setting. Executive level exposure and the 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 multidisciplinary teams. Highly proficient in HEDIS/Quality measures, cost and utilization.
Salary & Benefits Pay range:
$87,700.00 – $157,800.00 per year .
Benefits include competitive pay, health insurance, 401(k) and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field, or office schedules. Total compensation may also include additional incentive forms. Benefits may be subject to program eligibility.
Equal Employment Opportunity Centene is an equal‑opportunity employer 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 characteristics 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.
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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.
Responsibilities
Serve as a strategic partner/primary contact for hospital systems, multi‑specialty groups, and large PCP groups with Value Based/Risk components.
Execute provider performance improvement strategies in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc.
Build 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) to educate providers resulting in improved provider performance.
Resolve provider issues as needed for resolution to internal partners and create efficiencies to prevent continued concerns.
Receive and respond effectively to external provider‑related issues.
Investigate, resolve, and communicate provider high‑dollar and high‑volume claim issues and changes.
Educate providers regarding policies and procedures related to referrals, claim submission, web‑site usage, EDI solicitation and related topics.
Evaluate provider performance and develop a strategic plan to improve performance.
Present detailed HBR analysis and create reports for Joint Operating Committee (JOC) meetings.
Act as a lead for external representatives.
Coach and train external representatives.
Travel locally 4 days a week.
Perform other duties as assigned.
Comply with all policies and standards.
Education & Experience Bachelor’s degree in a related field or equivalent experience. 5+ years of managed care or medical group experience in provider relations, quality improvement, utilization management, or clinical operations. Project management experience in a medical group, IPA, or health plan setting. Executive level exposure and the 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 multidisciplinary teams. Highly proficient in HEDIS/Quality measures, cost and utilization.
Salary & Benefits Pay range:
$87,700.00 – $157,800.00 per year .
Benefits include competitive pay, health insurance, 401(k) and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field, or office schedules. Total compensation may also include additional incentive forms. Benefits may be subject to program eligibility.
Equal Employment Opportunity Centene is an equal‑opportunity employer 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 characteristics 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.
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