Provider Performance Specialist II

Summary

Centene Corporation is a healthcare organization focused on improving access to effective care. The Provider Performance Specialist II provides consultative support to providers by analyzing performance and member engagement data, identifying improvement opportunities, and facilitating discussions related to quality, utilization, cost, and risk.

Responsibilities

• Interpret performance data, prioritizing insights and developing discussion and presentation documents, including year-to-date results, month-over-month performance, and member engagement results
• Facilitate provider discussions regarding quality, utilization, and cost or risk performance improvement opportunities, utilizing corporate tools and reporting
• Collaborate with health plan quality counterpart to ensure coordinated communication and goal alignment for provider discussions
• Develop proficiency in tools and value based performance (VBP) and educate providers on the use of tools and interpretation of data
• Present detailed HBR (Health Benefits Ratio) analysis and create reports for Joint Operating Committee meetings
• Performs other duties as assigned
• Complies with all policies and standards

Skills

• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future
• Bachelor's degree in related field or equivalent experience
• 2+ years of combined managed healthcare and provider reimbursement experience
• Claims processing and/or managed care experience preferred
• Valid state clinical license preferred (i.e.- LPN, RN, etc.)

Qualifications

Must Haves

• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future
• Bachelor's degree in related field or equivalent experience
• 2+ years of combined managed healthcare and provider reimbursement experience

Nice to Haves

• Claims processing and/or managed care experience preferred
• Valid state clinical license preferred (i.e.- LPN, RN, etc.)

Benefits

• 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