VBC Performance Manager

Centene Management Company LLC; Missouri; Hybrid; USD 70,000 - 126,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible remote/field/office schedules

Job summary

Centene is seeking a Provider Relations professional to develop strategic partnerships with provider networks and drive performance improvements in cost, quality, and utilization. You will manage issues, educate providers on policies, and present detailed analyses for committee meetings.

The role requires 3+ years in managed care, strong communication, and knowledge of HEDIS/quality measures. Remote work within the United States is supported, with occasional travel.

Qualifications

• Bachelor’s degree in related field or equivalent experience.
• Three or more years of managed care or medical group experience.
• Strong communication and presentation skills.
• Proficient in HEDIS/Quality measures.
• Experience with Value Based Care is highly preferred.

Responsibilities

• Develop strategic partnerships between health plan and provider networks.
• Engage with providers to improve network performance and cost utilization.
• Consultative account management and issue resolution.
• Travel locally up to 10% as needed.

Skills

Provider relations

HEDIS/Quality measures

Value Based Care

Cost & utilization analysis

Strong communication

Presentation skills

Project management

Education

Bachelor’s degree in related field

Equivalent experience

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.

Location & Remote Work

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

Pay Range

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

Benefits

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

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.

Contact & Additional Information

Thanks for your interest in Centene and its subsidiary companies. We’re so glad that you’ve decided to fill out an application and take the next step to find your purpose. Also, we’re here to help support you on your candidate journey. Should you need an accommodation, please email [e-mail]. Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.