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Provider Performance Specialist II

Tigard, Oregon Apply Now Job ID 1152856 Category Health Insurance Operations Organization Trillium Community Health Plan Schedule Full-time
Description:

Position Purpose:

Interpret performance data, prioritizing insights and developing discussion and presentation documents, including year-to-date results, month-over-month performance, and member engagement results
Facilitate provider discussions regarding quality, utilization, and cost or risk performance improvement opportunities, utilizing corporate tools and reporting
Collaborate with health plan quality counterpart to ensure coordinated communication and goal alignment for provider discussions
Develop proficiency in tools and value based performance (VBP) and educate providers on the use of tools and interpretation of data
Present detailed HBR (Health Benefits Ratio) analysis and create reports for Joint Operating Committee meetings

Qualifications:

Provide consultative support to providers to improve their performance on member outreach, utilization management, cost, quality and risk. Discuss, analyze and interpret performance reporting, member engagement data and other data resources to identify opportunities for improving member outcomes.


Education/Experience:
Bachelor’s degree in related field or equivalent experience. 2+ years of combined managed healthcare and provider reimbursement experience. Claims processing and/or managed care experience preferred

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.

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