Director, Provider Network Performance

📋 Description

• • Centene Corporation is seeking a highly motivated and experienced Director, Provider Network Performance to join our transformative healthcare organization. In this pivotal role, you will be instrumental in shaping the future of healthcare for our 28 million members by driving improvements in provider network performance and fostering strong provider engagement. This is a fully remote position, offering the flexibility to work from anywhere within the continental United States, embodying our commitment to a fresh perspective on workplace flexibility.
• • The core mission of this role is to oversee and enhance the performance of our provider network, ensuring that our members receive high-quality, cost-effective care. You will be responsible for the strategic planning and operational execution of all initiatives aimed at achieving these goals. This includes collaborating closely with health plans and a diverse range of stakeholders to conceptualize and implement comprehensive plans for improving provider performance across the organization.
• • A key aspect of your role will involve developing and deploying effective training and communication tools and processes. These resources will be crucial for educating providers on network performance expectations, best practices, and the utilization of Centene's resources. You will also be tasked with defining the company-wide analytic reporting needs, ensuring that we have the data-driven insights necessary to monitor performance, identify trends, and make informed decisions. This includes providing essential training and support on network performance applications and reporting tools to internal teams and external partners.
• • You will work hand-in-hand with health plan leaders and providers to conduct thorough reviews of network performance. This deep dive will encompass critical metrics such as quality of care, cost-effectiveness, identification and closure of care gaps, and the accuracy of risk adjustment. Based on these analyses, you will collaborate to develop targeted improvement plans designed to address identified deficiencies and capitalize on opportunities for enhancement.
• • This position requires oversight of provider profiling and network performance analytic support functions. You will ensure that these functions are robust, accurate, and provide valuable support to health plans and other stakeholders. This includes analyzing provider Health Benefits Ratio (HBR), evaluating quality metrics, understanding unit cost and utilization trends, and proactively identifying and implementing network improvement opportunities that align with Centene's strategic objectives.
• • Furthermore, you will be responsible for overseeing the support and continuous improvement of existing application tools. The goal is to enhance their outcomes and functionality, making them more effective in driving network performance and supporting our mission. This involves staying abreast of technological advancements and best practices in healthcare analytics and performance management.
• • The ideal candidate will possess a Bachelor's degree in Business, Economics, Finance, Healthcare, or a related field, coupled with over 7 years of experience in contracting, healthcare reimbursement, provider contract modeling, or quality measurement. Prior experience in building and managing relationships with healthcare providers is highly preferred, as is specific experience in Medicare quality and financial performance, and provider relations. This role offers a unique opportunity to make a significant impact on the health and well-being of millions, working within a dynamic and supportive environment at a leading healthcare organization.