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About the Role
Provide consultative support to providers to improve their performance on member outreach, utilization management, cost, quality, and risk. Analyze performance reporting, member engagement data, and other data resources to identify opportunities for improving member outcomes.
Responsibilities
- Interpret performance data, prioritizing insights and developing discussion and presentation documents.
- Facilitate provider discussions regarding quality, utilization, and cost or risk performance improvement opportunities.
- Collaborate with health plan quality counterpart to ensure coordinated communication and goal alignment.
- Develop proficiency in tools and value-based performance (VBP) and educate providers on tool usage and data interpretation.
- Present detailed HBR (Health Benefits Ratio) analysis and create reports for Joint Operating Committee meetings.
- Perform other duties as assigned.
- Comply with all policies and standards.
Requirements
- Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.
- Claims processing and/or managed care experience preferred.
- Valid state clinical license preferred (i.e.- LPN, RN, etc.) for Fidelis Care NY Only.
Skills
- Managed healthcare
- Provider reimbursement
- Claims processing
- Managed care
- Data analysis
- Presentation skills
- Communication
Location
- New York City area
Work Type
- Field based
- Remote
- Hybrid
- Office
Experience Level
- 2+ years of combined managed healthcare and provider reimbursement experience
Education Level
- Bachelor’s degree in related field or equivalent experience
Salary/Compensations
- $56,200.00 - $101,000.00 per year
Benefits
- Competitive pay
- Health insurance
- 401K and stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- Flexible approach to work
About the Company
- Centene connects people to the care they need to live healthier lives.
- The work done at Centene makes an impact every day.
- Centene offers a comprehensive benefits package.
- Centene is committed to improving lives well beyond the workday.
Equal Opportunity
- 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.