Remote Value-Based Care Performance Manager

centene; United States; On-site; USD 70,000 - 126,000; Full time

Job summary

Centene is seeking a remote Provider Relations Manager to build strategic partnerships with health plans and contracted provider networks across the United States. You will align on network performance opportunities, manage issues, and drive improvements in cost, utilization and quality.

Travel up to 10% may be required. The role requires a bachelor’s degree and 3+ years in managed care with strong communication and PM skills.

Qualifications

• Bachelor's degree in related field or equivalent experience.
• 3+ years of managed care or provider relations, quality improvement, claims, contracting, utilization management, or clinical operations.
• PM experience at a medical group, IPA, or health plan setting.
• Strong communication and presentation skills.
• Proficient in HEDIS/Quality measures, cost and utilization.
• Experience with Value Based Care is highly preferred.

Responsibilities

• Serve as primary contact for providers and act as a liaison between the providers and the health plan ensuring a coordinated effort in improving financial and quality performance
• Identify and deliver solutions to providers concerns and issues as needed for resolution to internal partners
• Receive and effectively respond to external provider related issues
• Investigate, resolve and communicate provider claim issues and changes
• Engage with and educate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics
• Perform provider orientations and ongoing provider education, including writing and updating orientation materials
• Manages Network performance for assigned territory through a consultative/account management approach
• Evaluates provider performance and develops strategic plan to improve performance
• Drives provider performance improvement in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc.
• Present detailed HBR analysis and create reports for Joint Operating Committee meetings (JOC)
• Develop proficiency in tools and value based performance (VBP) and educate providers on use of tools and interpretation of data
• Coaches new and less experienced External Reps
• Ability to travel locally 4 days a week
• Performs other duties as assigned
• Complies with all policies and standards

Skills

Project management

Provider relations

Quality improvement

HEDIS/Quality measures

Cost and utilization analysis

Presentation skills

Education

Bachelor's degree in related field or equivalent experience

Job description

Centene is seeking a remote Provider Relations Manager to build strategic partnerships with health plans and contracted provider networks across the United States. You will align on network performance opportunities, manage issues, and drive improvements in cost, utilization and quality.

Travel up to 10% may be required. The role requires a bachelor’s degree and 3+ years in managed care with strong communication and PM skills.