Field Provider Performance Specialist II – NYC

Centene Corporation; New York (NY); Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Remote, hybrid, field or office work S

Flexible work arrangements

Job summary

Centene Corporation is seeking a field-based professional in the New York City area to support providers in improving member outreach, utilization management, quality, and cost outcomes. You will interpret performance data, present insights, and collaborate with health plan quality teams to align goals and messaging.

The role requires a bachelor’s degree and 2+ years in managed care or provider reimbursement; Fidelis Care NY license is preferred.

Qualifications

• Bachelor’s degree in related field or equivalent experience.
• 2+ years of combined managed healthcare and provider reimbursement experience.
• Claims processing and/or managed care experience preferred.
• For Fidelis Care NY Only: Valid state clinical license preferred (i.e.- LPN, RN, etc.)

Responsibilities

• Interpret performance data, prioritizing insights and developing discussion and presentation documents, including year-to-date results, month-over-month performance, and member engagement results.
• Facilitate provider discussions regarding quality, utilization, and cost or risk performance improvement opportunities, utilizing corporate tools and reporting.
• Collaborate with health plan quality counterpart to ensure coordinated communication and goal alignment for provider discussions.
• Develop proficiency in tools and value based performance (VBP) and educate providers on the use of tools and interpretation of data.
• Present detailed HBR (Health Benefits Ratio) analysis and create reports for Joint Operating Committee meetings.
• Performs other duties as assigned.
• Complies with all policies and standards.

Skills

Data interpretation

Performance reporting

Provider discussions

Quality collaboration

Value Based Performance

HBR analysis

Presentation skills

Education

Bachelor’s degree or equivalent experience

2+ years managed healthcare experience

Claims processing / managed care experience preferred

Fidelis Care NY license preferred

Job description

Centene Corporation is seeking a field-based professional in the New York City area to support providers in improving member outreach, utilization management, quality, and cost outcomes. You will interpret performance data, present insights, and collaborate with health plan quality teams to align goals and messaging.

The role requires a bachelor’s degree and 2+ years in managed care or provider reimbursement; Fidelis Care NY license is preferred.