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.
* Qualified candidates must reside in California *
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.Additional Responsibilities:
Candidate Education: Required A Bachelor's Degree in a related field
Candidate Experience: Required 8+ years of experience in provider relations experience
- Required 5+ years of management experience
Preferred Other Managed care experience
Pay Range: $145,100.00 - $268,800.00 per year
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
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