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Centene Corporation · 11 hours ago

VBC Performance Manager

New York, United States

Full-time

Hybrid

Mid Level

$70K/yr - $126K/yr

3+ years exp

Centene Corporation is transforming the health of communities, one person at a time. The VBC Performance Manager will develop strategic partnerships with provider networks, drive performance improvements, and serve as a liaison to enhance financial and quality outcomes.

Hospital & Health Care

Responsibilities

Develop strategic partnerships between the health plan and the contracted provider networks serving our communities

Engage with providers to align on network performance opportunities and solutions, and consultative account management and accountability for issue resolution

Drive optimal performance in contract incentive performance, quality, and cost utilization

Participate in the development of network management strategies

Assist in the strategic implementation of new initiatives for performance improvement

Serve as primary contact for providers and act as a liaison between the providers and the health plan ensuring a coordinated effort in improving financial and quality performance

Identify and deliver solutions to providers concerns and issues as needed for resolution to internal partners

Receive and effectively respond to external provider related issues

Investigate, resolve and communicate provider claim issues and changes

Engage with and educate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics

Perform provider orientations and ongoing provider education, including writing and updating orientation materials

Manage Network performance for assigned territory through a consultative/account management approach

Evaluate provider performance and develop strategic plan to improve performance

Drive provider performance improvement in the following areas Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc

Present detailed HBR analysis and create reports for Joint Operating Committee meetings (JOC)

Develop proficiency in tools and value based performance (VBP) and educate providers on use of tools and interpretation of data

Coach new and less experienced External Reps

Ability to travel locally 4 days a week

Perform other duties as assigned

Comply with all policies and standards

Qualification

Managed care experienceProvider relationsQuality improvementHEDIS/Quality measuresProject managementCommunication skillsPresentation skills

Required

Bachelor's degree in related field or equivalent experience

Three or more years of managed care or medical group experience, provider relations, quality improvement, claims, contracting, utilization management, or clinical operations

Project management experience at a medical group, IPA, or health plan setting

Strong communication and presentation skills

Proficient in HEDIS/Quality measures, cost and utilization

Ability to travel locally 4 days a week

Preferred

Highly preferred that candidate resides in the state of New York, in either Nassau, Suffolk, Queens, Brooklyn, Manhattan, Bronx, Westchester or surrounding areas