NYC Field-Based Provider Performance Specialist II

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

Job summary

Centene is seeking a field-based health care consultant in the New York City area to help providers improve outcomes through data-driven insights. You will analyze performance and engage with providers to drive quality, utilization and cost improvements.

You will present HBR analyses, develop Joint Operating Committee reports, and work with health plan quality partners to align goals and ensure policy compliance.

Qualifications

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

Responsibilities

• Provide consultative support to providers to improve performance on outreach, utilization, cost, quality and risk.
• Interpret performance data and present insights, including year-to-date results and month-over-month performance.
• Facilitate provider discussions on quality, utilization, and cost/risk performance improvements.
• Collaborate with health plan quality counterpart for coordinated communication and goal alignment.
• Develop proficiency in tools and value based performance (VBP) and educate providers on data interpretation.
• Present detailed HBR analyses and create reports for Joint Operating Committee meetings.
• Complies with all policies and standards.

Skills

Provider reimbursement

Data analysis

Performance reporting

Presentation

Education

Bachelor's degree or equivalent

2+ years healthcare experience

Tools

VBP tools

Reporting tools

Job description

Centene is seeking a field-based health care consultant in the New York City area to help providers improve outcomes through data-driven insights. You will analyze performance and engage with providers to drive quality, utilization and cost improvements.

You will present HBR analyses, develop Joint Operating Committee reports, and work with health plan quality partners to align goals and ensure policy compliance.