Provider Performance & Quality Improvement Specialist

Centene; United States; Remote; USD 56,000 - 101,000; Full time

Job summary

Centene is seeking a field-based healthcare professional in the New York City area to provide consultative support to providers, aiming to improve member outcomes through performance data analysis and strategic discussions.

The role emphasizes interpreting year-to-date results, presenting insights, and coordinating with quality teams to align goals. A Bachelor’s degree and 2+ years in managed care or provider reimbursement are required, with visa sponsorship not available.

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.

Responsibilities

• Provide consultative support to providers to improve performance on member outreach, utilization management, cost, quality and risk.
• Interpret performance data and develop year-to-date and month-over-month results.
• Facilitate provider discussions on quality, utilization, and cost/risk improvement opportunities.
• Collaborate with health plan quality counterparts for aligned goals.
• Develop proficiency in tools and value based performance (VBP) and educate providers on data usage.
• Present detailed HBR analyses and create reports for Joint Operating Committee meetings.

Skills

Provider reimbursement

Data interpretation

Performance reporting

Stakeholder communication

Education

Bachelor’s degree in related field

Job description

Centene is seeking a field-based healthcare professional in the New York City area to provide consultative support to providers, aiming to improve member outcomes through performance data analysis and strategic discussions.

The role emphasizes interpreting year-to-date results, presenting insights, and coordinating with quality teams to align goals. A Bachelor’s degree and 2+ years in managed care or provider reimbursement are required, with visa sponsorship not available.