Value-Based Care Performance Manager (Remote)

Centene Corporation; Missouri; Hybrid; USD 70,000 - 126,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Job summary

Centene Corporation is seeking a Provider Relations Manager to develop strategic partnerships between the health plan and contracted provider networks. You will drive performance in cost, quality, and utilization while mentoring provider relations staff.

This remote role requires up to 10% travel and 3+ years in managed care or provider relations. Strong communication, presentation skills, and knowledge of HEDIS/quality measures are essential, with preference for Value Based Care experience.

Qualifications

• Bachelor’s degree in a related field and 3+ years in managed care or provider relations.
• Strong communication and presentation skills.
• Experience with HEDIS/Quality measures and cost/utilization.
• Experience with Value Based Care preferred.
• Remote work from anywhere in the United States with up to 10% travel.

Responsibilities

• Serve as primary contact for providers and act as a liaison between the providers and the health plan, ensuring coordinated effort in improving financial and quality performance.
• Identify and deliver solutions to provider concerns and issues for resolution with internal partners.
• Respond to external provider-related issues promptly and effectively.
• Investigate, resolve and communicate provider claim issues and changes.
• Educate providers on policies and procedures related to referrals, claims submission, web portal usage, EDI, and related topics.
• Conduct provider orientations and ongoing provider education, including updating materials.
• Manage network performance for the assigned territory using a consultative/account management approach.
• Evaluate provider performance and develop strategic plans to improve performance.
• Drive provider performance improvement in risk/P4Q, HBR, HEDIS/quality, cost and utilization.
• Present detailed HBR analysis for Joint Operating Committee meetings.
• Develop proficiency in VBP tools and educate providers on use and interpretation of data.
• Coach new and less experienced External Reps.
• Travel locally up to 4 days a week.
• Comply with all policies and standards.

Skills

Communication

Account management

Problem solving

Presentation

Project management

HEDIS knowledge

Value Based Care understanding

Education

Bachelor's degree

Job description

Centene Corporation is seeking a Provider Relations Manager to develop strategic partnerships between the health plan and contracted provider networks. You will drive performance in cost, quality, and utilization while mentoring provider relations staff.

This remote role requires up to 10% travel and 3+ years in managed care or provider relations. Strong communication, presentation skills, and knowledge of HEDIS/quality measures are essential, with preference for Value Based Care experience.