Job Description

Job Description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: Lead provider and health plan strategy related to performance improvement on cost, quality, coding and member outreach and engagement. Responsible for ongoing review of performance reporting and data, interpreting and prioritizing results; utilize tools and resources to identify performance insights; work with health plan and provider functional leadership to present results and recommend actions to providers. Manage provider performance in all levels of value-based agreements, including quality & utilization pay for performance and risk contracts.

Remote but must reside in Hawaii.

• Develop provider performance improvement strategy at the plan and provider levels
• Analyze and interpret cost and quality data to determine performance insights and prioritize provider actions
• Facilitate joint operating committee (JOC) performance discussions and work cross-functionally to build consensus on priorities and actions to improve performance
• Present financial, medical cost and quality performance data to provider leadership
• Support value-based contract negotiations through the contract value and support model
• Provide high-level recommendations to providers and health plan leadership regarding opportunities to optimize clinical workflow to increase member outreach and care coordination
• Understand member population and provider variation by line of business to most effectively support providers with performance improvement
• Develop proficiency in tools and value based contracting and educate providers on the use of tools and interpretation of data

Education/Experience: Bachelor’s Degree in Healthcare Administration, Business Administration, or similar field; Master’s degree preferred. 7+ years of experience in managed care, value-based contracting, or clinical experience.

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. Total compensation may also include additional forms of incentives.

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.

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