Senior Director, Provider Engagement

Centene

259d • $145,100 - $268,800 • Remote

About The Position

This role specifically manages PCP and Medical Specialist providers across the state of Florida. Key responsibilities include driving the health plan's quality performance to maintain a high quality network. Creates and implements Network Transformation initiatives across a market. Develops Provider Relations Management team to effectively achieve market targets while collaborating with internal departments to drive improvement of provider performance. Leads and develops team of Provider Relations Managers and/or Network Performance advisors to meet/exceed provider performance and provider satisfaction key metrics. Conducts field rides with Provider Relations Representatives to gauge their performance and provide coaching and development in order to improve the business results. Identifies team skill set deficiencies and implements proper professional development plans. Monitors Provider Performance action plans and tracks provider performance improvement. Implements strategy to provide a positive impact on the provider experience. Ensures compliance with enterprise provider performance and relationship model and team engagement of provider performance reporting. Drives improvement of provider performance by analyzing, interpreting and communicating financial, utilization and quality metrics. Establishes and leads collaborative effort with internal cross-functional market and shared services departments to support provider performance and resolve network and operational barriers/challenges. Responsible for understanding HEDIS and STARS measures and partners with Quality Team to drive improvement of quality provider performance. Responsible for understanding the differences between Risk and Value-Based contractual arrangements. Plans, prepares and executes effective group meetings/discussions with proper objectives and outcomes. Plans, conducts and directs provider contractual terms and provider account management. Assists in monitoring and developing High Performing Practices and drives Network Transformation Strategies to optimize member outcomes. Strategizes membership growth and retention for High Performing Practices, sophisticated and/or complex Provider Partnerships. Maintains compliance for State and CMS audits. Resolves high level, complex provider issues. Member of state senior leadership team. Special projects as assigned or directed.

Requirements

• Bachelor's Degree in a related field.
• 8+ years of experience in provider relations.
• 5+ years of management experience.
• Managed care experience preferred.
• Valid Florida driver's license required.

Responsibilities

• Manage PCP and Medical Specialist providers across Florida.
• Drive health plan's quality performance to maintain a high quality network.
• Create and implement Network Transformation initiatives.
• Develop Provider Relations Management team to achieve market targets.
• Lead and develop team of Provider Relations Managers and/or Network Performance advisors.
• Conduct field rides with Provider Relations Representatives for performance evaluation.
• Identify team skill set deficiencies and implement professional development plans.
• Monitor Provider Performance action plans and track performance improvement.
• Implement strategies to enhance provider experience.
• Ensure compliance with enterprise provider performance and relationship model.
• Drive improvement of provider performance through analysis of metrics.
• Establish collaborative efforts with internal departments to support provider performance.
• Understand HEDIS and STARS measures to drive quality provider performance.
• Plan and execute effective group meetings/discussions.
• Conduct provider contractual terms and account management.
• Assist in monitoring and developing High Performing Practices.
• Strategize membership growth and retention for High Performing Practices.
• Maintain compliance for State and CMS audits.
• Resolve high level, complex provider issues.
• Participate as a member of the state senior leadership team.
• Handle special projects as assigned.

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible work schedules (remote, hybrid, field, or office work)

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Industry: Ambulatory Health Care Services
• Education Level: Bachelor's degree