ProfessionalPosition Purpose: Oversee efforts to improve provider network performance and promote provider engagement. Oversee the planning and operations of all activities related to provider network performance.
Collaborate with health plans and various stakeholders to develop overall plan for improving provider performance
Develop effective training and communication tools and processes related to provider network performance
Provide direction to determine company-wide analytic reporting needs and provide training and support on network performance applications and reporting tools
Collaborate with health plan leaders and providers to review network performance, including quality, cost, care gaps, and risk adjustment gaps, and develop improvement plans
Oversee provider profiling and network performance analytic support functions and provide support to health plans and other stakeholders
Oversee the evaluation of provider Health Benefits Ratio (HBR), quality, unit cost and utilization trends and identify and implement network improvement opportunities
Oversee the support and improvements of existing application tools to enhance outcomes and functionality
Education/Experience: Bachelor's degree in Business, Economics, Finance, Healthcare or related field. 7+ years of contracting, health care reimbursement, provider contract modeling or quality measurement experience. Prior experience building and managing relationships with health care providers preferred.
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.
TITLE: Director, Provider Network Performance
LOCATION: Sunrise, Florida
COMPANY: Leadership, Quality Assurance
POSITION TYPE: Professional