Senior Director, Provider Relations

Centene Corporation

1d•Remote

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: 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. 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 project as assigned or directed.

Requirements

8+ years of experience in provider relations experience required.
5+ years of management experience required.
Bachelor's Degree in a related field required
Candidates must reside in California in order to be considered.

Responsibilities

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.
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 project as assigned or directed.