Vice President, Provider Engagement

Centene Corporation•New York, NY

1d•Hybrid

About The Position

This leader advances payment models/programs that improve quality, affordability, provider performance, and member outcomes while ensuring alignment with Fidelis Care’s network strategy, line of business priorities, state specific needs, and regulatory requirements. This role is responsible for leading all aspects of provider services, including building and maintaining strong provider relations with key providers and working closely with various operational areas to support provider services, quality initiatives, network development, data quality initiatives, claim processing and expansion of the markets served by the company. The VP of Provider Engagement works closely with others to ensure that members have access to best-in-class service providers and that members receive quality care at reasonable costs.

Requirements

Bachelor's Degree required.
9+ years experience in senior leader roles in managed care environment at a Healthcare payer organization required.
Highly developed knowledge of healthcare industry, provider network, claim processing, UM guidelines and health plan operations.

Nice To Haves

Master's Degree preferred.
Experience focused specifically on developing provider networks and building partnerships preferred.

Responsibilities

Develops and implements market-level network value based program transformation initiatives.
Develop and execute overarching strategies to optimize provider performance, operations and satisfaction across the market.
Analyzes and communicates financial, utilization, and quality metrics to improve performance, specifically focusing on HEDIS and STARS measures.
Manages relationships with complex provider partnerships to improve value based performance, provider satisfaction and retention.
Foster direct collaboration between providers and the health care plan to reduce rework, streamline administration and reduce costs for all constituents.
Collaborate with all functions within the company to develop services and processes that streamline claim adjudication, achieve a high level of compliance and customer satisfaction.
Lead the development of provider related corporate initiatives, business plans, strategies, and goals.
Manage efforts to partner with providers to achieve high quality results consistent with QARR and HEDIS measures.
Collaborate with operational areas and appropriate vendors on initiatives that support claim processing and financial efficiencies.
Monitor new trends in provider network, reimbursement and services.
Design and implement strategies to capitalize on new trends.
Enhance and leverage analytics, member demographics, and healthcare facility usage patterns to identify efficiency opportunities and target service providers for direct contracts.
Maintain local and state government relationships, including dealing with regulators as necessary to establish and continue effective working relationships.
Attract, recruit and retain the talent Provider Relations needs to achieve its objectives.
Provide mentoring and foster a success-oriented and accountable culture.
Coordinate and Communicate annual Provider Satisfaction Survey consistent with NCQA standards.
Provide oversight to internal provider credentialing process, ensuring adherence to credentialing policies and procedures.
Collaborate with others on data that impacts provider domain to ensure that provider data is being maintained consistent with internal data governance standards.