VBC Performance Manager

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

Position Purpose:

Develop strategic partnerships between the health plan and the contracted provider networks serving our communities. Engage with providers to align on network performance opportunities and solutions, and consultative account management and accountability for issue resolution. Drive optimal performance in contract incentive performance, quality, and cost utilization. Participate in the development of network management strategies. Assists in the strategic implementation of new initiatives for performance improvement.

Key Details:

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.

• 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

Education/Experience:

Bachelor’s degree in related field or equivalent experience.
Three or more years of managed care or medical group experience, provider relations, quality improvement, claims, contracting, utilization management, or clinical operations.
Project management 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 and understanding of Value Based Care is highly preferred.

This is a remote position open to someone working anywhere in the United States. it will require occasional travel up to 10%.

Pay Range: $70,100.00 - $126,200.00 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.

Centene offers a comprehensive benefits package including:

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• 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.

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