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.
Candidates must live in Los Angeles or Southern California – Riverside, San Bernadino Area…
Position Purpose: Develop strategic partnerships between the health plan and the contracted provider networks serving our communities. Engage with providers to align on network performance opportunities and solutions, and consultative account management and accountability for issue resolution. Drive optimal performance in contract incentive performance, quality, and cost utilization. Participate in the development of network management strategies. Assists in the strategic implementation of new initiatives for performance improvement.
• Develop effective relationships with assigned providers that results in improved performance on quality, satisfaction and growth
• Partner with assigned providers to ensure we are the easiest health plan to work with
• Coordinate the operations of the team, including managing provider assignments and coverage arrangements for staff
• Solve provider problems and complaints
• Lead and coordinate state-wide and department projects and initiatives
• Coach and develop team members
• Manage training and onboarding for new hires
• Manage on-going training and competency assessment needs
• Communicate effectively and efficiently
• Participate in ride-along and observations
• For Collaborative Health Systems Only:
• Develop and maintain strong relationships with assigned affiliated provider groups, including decision makers and office staff to understand the groups business operations from processes to workflow
• Actively participate in cross-functional teams to conduct work and resolve enterprise and regional issues
• Liaison between assigned practices and cross-functional teams related to services provided or other issues identified that could impact success in Value Based programs
• Conducts needs assessments and design untapped resources, materials and/or trainings to help boost performance improvement capacity across cross-functional departments
• Serve as the main point of contact for assigned practices during implementation phase
• Performs other duties as assigned
• Complies with all policies and standards
Education/Experience: Bachelor’s degree in related field or equivalent experience. 4+ years of managed care or medical group experience, provider relations, quality improvement, claims, contracting, utilization management, or clinical operations. Supervisory or lead experience. Project management experience at a medical group, IPA, or health plan setting. Strong communication and presentation skills. Proficient in HEDIS/Quality measures, cost and utilization. Change management, project management, previous experience as a practice transformation coach preferred.
Pay Range: $67,400.00 – $121,300.00 per year
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. Total compensation may also include additional forms of incentives.
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
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