Provider Performance Specialist II

Centene; United States; Teletrabalho; USD 56 000 - 101 000; Tempo integral

Resumo da oferta

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.

Qualificações

• 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.

Responsabilidades

• 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.

Conhecimentos

Provider reimbursement

Data interpretation

Performance reporting

Stakeholder communication

Formação académica

Bachelor’s degree in related field

Descrição da oferta de emprego

Remote

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/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

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.