Director, Provider Network Performance
Western Sky Community Care
Job location
Albuquerque, NM
Job details
You could be the one who changes everything for our 26 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: Oversee efforts to improve provider network performance and promote provider engagement Oversee the planning and operations of all activities related to provider network performance.
• Collaborate with health plans and various stakeholders to develop overall plan for improving provider performance
• Develop effective training and communication tools and processes related to provider network performance
• Provide direction to determine company-wide analytic reporting needs and provide training and support on network performance applications and reporting tools
• Collaborate with health plan leaders and providers to review network performance, including quality, cost, care gaps, and risk adjustment gaps, and develop improvement plans
• Oversee provider profiling and network performance analytic support functions and provide support to health plans and other stakeholders
• Oversee the evaluation of provider Health Benefits Ratio (HBR), quality, unit cost and utilization trends and identify and implement network improvement opportunities
• Oversee the support and improvements of existing application tools to enhance outcomes and functionality
Education/Experience: Bachelor’s degree in Business, Economics, Finance, Healthcare or related field. 7+ years of contracting, health care reimbursement, provider contract modeling or quality measurement experience. Prior experience building and managing relationships with health care providers preferred.
License:
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
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
