Network Performance Advisor

Centene Corporation

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. Candidates must reside in Florida. Position Purpose: The Network Performance Advisor (NPA) serves as a key point of contact and liaison between assigned strategic providers and various departments within WellCare, including Quality, Operations, Finance, Health Services and other shared services departments. The NPA is responsible for ensuring white glove service to the providers. The NPA will develop and execute the strategy for their assigned providers, including building strong working relationship; building trust, maintaining high provider satisfaction and helping providers improve their performance. The Network Performance Advisor will be responsible for executing Network Transformation Strategies in order to manage overall network performance. The NPA will be responsible for the provider's overall performance. Owns and manages the relationship and performance of key provider groups. Influences provider behaviors to drive improvements in provider & member satisfaction, optimizing member outcomes and maximizing shared savings. Drives improvement of provider performance by analyzing, interpreting and communicating financial, utilization and quality metrics. Establishes and leads cross-functional communication and collaboration with internal departments to support provider performance and resolve barriers and challenges. Serves as a primary liaison to providers on claim related content working with other departments for resolution. Responsible for understanding the differences between Risk and Value-Based contracting and driving improved provider performance. Plans, prepares, and executes effective group meetings/discussions with proper objectives and outcome. Responsible for understanding unique contract, quality, network requirements of Medicaid and Medicare. Responsible for understanding HEDIS and STARS measures and partner the Quality team to drive improved provider performance. Special projects as assigned or directed. Performs other duties as assigned Complies with all policies and standards

Requirements

A Bachelor's Degree in Health Care, Business, Finance or any other field: Required or equivalent work experience in Network Management/Network Development, Provider Relations, Risk and /or Value Base Contracting
5+ years of experience in Network Management/Network Development, Provider Relations, Risk and/or Value Base Contracting, managed care organization
2+ years of experience in Account Management or management experience

Responsibilities

Owns and manages the relationship and performance of key provider groups.
Influences provider behaviors to drive improvements in provider & member satisfaction, optimizing member outcomes and maximizing shared savings.
Drives improvement of provider performance by analyzing, interpreting and communicating financial, utilization and quality metrics.
Establishes and leads cross-functional communication and collaboration with internal departments to support provider performance and resolve barriers and challenges.
Serves as a primary liaison to providers on claim related content working with other departments for resolution.
Responsible for understanding the differences between Risk and Value-Based contracting and driving improved provider performance.
Plans, prepares, and executes effective group meetings/discussions with proper objectives and outcome.
Responsible for understanding unique contract, quality, network requirements of Medicaid and Medicare.
Responsible for understanding HEDIS and STARS measures and partner the Quality team to drive improved provider performance.
Special projects as assigned or directed.
Performs other duties as assigned
Complies with all policies and standards