Director, Provider Network Performance

Centene Corporation

1d

About The Position

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. Position Purpose: Oversee efforts to improve provider network performance and promote provider engagement. Oversee the planning and operations of all activities related to provider network performance. Collaborate with health plans and various stakeholders to develop overall plan for improving provider performance Develop effective training and communication tools and processes related to provider network performance Provide direction to determine company-wide analytic reporting needs and provide training and support on network performance applications and reporting tools Collaborate with health plan leaders and providers to review network performance, including quality, cost, care gaps, and risk adjustment gaps, and develop improvement plans Oversee provider profiling and network performance analytic support functions and provide support to health plans and other stakeholders Oversee the evaluation of provider Health Benefits Ratio (HBR), quality, unit cost and utilization trends and identify and implement network improvement opportunities Oversee the support and improvements of existing application tools to enhance outcomes and functionality

Requirements

• Bachelor’s degree in Business, Economics, Finance, Healthcare or related field.
• 7+ years of contracting, health care reimbursement, provider contract modeling or quality measurement experience.

Nice To Haves

• Prior experience building and managing relationships with health care providers preferred.

Responsibilities

• Oversee efforts to improve provider network performance and promote provider engagement.
• Oversee the planning and operations of all activities related to provider network performance.
• Collaborate with health plans and various stakeholders to develop overall plan for improving provider performance
• Develop effective training and communication tools and processes related to provider network performance
• Provide direction to determine company-wide analytic reporting needs and provide training and support on network performance applications and reporting tools
• Collaborate with health plan leaders and providers to review network performance, including quality, cost, care gaps, and risk adjustment gaps, and develop improvement plans
• Oversee provider profiling and network performance analytic support functions and provide support to health plans and other stakeholders
• Oversee the evaluation of provider Health Benefits Ratio (HBR), quality, unit cost and utilization trends and identify and implement network improvement opportunities
• Oversee the support and improvements of existing application tools to enhance outcomes and functionality

Benefits

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• a flexible approach to work with remote, hybrid, field or office work schedules

What This Job Offers

• Job Type: Full-time
• Career Level: Director