You could be the one who changes everything for our 28 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.
This role requires the individual to live in the Houston TX market.
Position Purpose: Oversee and manage the operational and financial performance of the Medicare product across all markets to establish and maintain high performance in key areas including Star/Quality Ratings, risk adjustment, utilization, and unit-cost. Responsible for managing multiple large, cross-functional projects.
- Monitor overall provider performance utilizing performance reports (i.e., quality, utilization, referral management, risk), provider engagement activities, and team feedback.
- Understand, develop, and implement HCC improvement activities
- Implement provider change management activities: organize and structure provide education sessions, develop tools with their team to establish provider profiles and insights to identify key areas in the workflow that can improve to better align in office activities such as AWV workflow, EMR template design, and scheduling processes.
- Understand, develop, and implement quality improvement activities such as colorectal screening programs, education webinars, EMR improvement activities, medication management (pill delivery programs), and aligning efforts through market vendors
- Analyze data through Excel and technology: analyze claims data, performance reports, and utilization reports
- Network development and provider relations: use data to identify and establish relationships with key specialty groups to provide patient care and lower cost. Establish JOC with network to identify opportunities to improve through data and referral management with PCPs
- Develop long and short-term goals with tracking metrics: establish role-based goals that align with CHS organization goals. Work with team members to identify key activities that directly impact the goals of the entity. Work with the ACO management team to identify specific goals for the ACO to help improve quality or performance.
Education/Experience: Bachelor’s degree in Business Administration, Healthcare Administration, or a related field or equivalent experience. Master’s degree preferred. 5+ years of product performance management experience including both quantitative & qualitative performance measures.
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.
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.