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

Position Purpose

Provide consultative support to providers to improve their performance on member outreach, utilization management, cost, quality and risk. Discuss, analyze and interpret performance reporting, member engagement data and other data resources to identify opportunities for improving member outcomes.

Key Details

This is a field based position in the New York City area. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT. 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.

Education and Experience

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.)

Pay Range

$56,200.00 - $101,000.00 per year

About Centene

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday. 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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Equal Opportunity Employer

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.