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: Perform initial health plan orientation and conduct ongoing educational outreach with a focus on improving quality and financial outcomes within provider network

• Conduct initial provider orientations as well as ongoing educational outreach

• Educate providers regarding policies and procedures related to referrals, claims submission, web site education, Electronic Health Records, Health Information Exchange, and Electronic Data Interface

• Engage providers on Patient Centered Medical Home initiatives

• Perform detailed HBR (Health Benefits Ratio) analysis and create reports for provider Review provider performance by both quantitative metrics and qualitative factors

• Create and communicate milestone documents, dashboards and success metrics

• Act as a liaison between the provider and the health plan ensuring a coordinated effort in improving financial and quality performance

• Provide status updates for providers regarding incentive agreements

• Conduct site visits when required and other Contracting duties as requested

• Ability to travel
• Performs other duties as assigned

• Complies with all policies and standards

Education/Experience: Bachelor’s Degree in related field or equivalent experience. 3 + years of combined managed healthcare and provider reimbursement experience. Clinical or health information management (HIM) experience preferred. Current state driver’s license.

For Fidelis Care only: Must have valid driver license, personal vehicle and ability to travel.

This team really needs someone who has prior experience working with healthcare providers on HEDIS, other Quality-related metrics, and process/quality improvement.

Candidates must be in the down state New York/New York City area to be considered for this role. This is remote/field based work that requires spending 50% of the time traveling locally to see providers in person.

Pay Range: $55,100.00 - $99,000.00 per year

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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Job Tags

Holiday work, Remote job, Flexible hours,

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