Description
Position Purpose: Within our Oregon's Trillium Community Health Plan Provider Contracting team, you will serve as the primary business lead for provider network adequacy monitoring, reporting, and strategic network analysis across Medicaid and Medicare lines of business.
Key Details: This is a fully remote role. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.
- Conducting routine and ad hoc provider network analysis by geography, specialty, and line of business.
- Monitoring network adequacy performance and identifying potential gaps and access issues.
- Leading monthly and quarterly Network Adequacy Committee (NAC) meetings and developing supporting reporting materials.
- Managing network gap remediation efforts through collaboration with Contracting, Provider Data Operations, Provider Engagement, Credentialing, Compliance, and Network Operations teams.
- Preparing network adequacy reporting for internal leadership and regulatory requirements.
- Supporting annual Medicaid and Medicare network adequacy exception request processes when applicable.
- Performing provider network impact analyses related to contract negotiations, terminations, and network strategy initiatives.
- Developing, maintaining, and improving reporting tools, dashboards, trackers, business documentation, and process workflows.
- Coordinating cross-functional workgroups and ensuring action items are tracked through completion.
- Serving as a subject matter resource for provider network composition, access, adequacy, and reporting.
- Performs other duties as assigned.
- Complies with all policies and standards.
Preferred Skills:
- Experience with healthcare network operations, provider contracting, network adequacy, provider data management, or managed care organizations.
- Strong analytical and problem-solving skills with experience interpreting large data sets and transforming findings into actionable recommendations.
- Advanced Excel and reporting capabilities, including pivot tables, lookups, data validation, and reporting automation.
- Experience working with Power BI, reporting tools, or business intelligence platforms.
- Strong project management and organizational skills with the ability to manage multiple priorities simultaneously.
- Experience facilitating meetings and leading cross-functional workgroups.
- Excellent written and verbal communication skills.
- Ability to present data and recommendations to leaders and business stakeholders.
- Knowledge of Medicaid, Medicare Advantage, and Commercial network requirements is highly preferred.
- Experience with healthcare regulatory reporting, network adequacy standards, or provider network access analysis is strongly preferred.
Education/Experience: Bachelor's Degree in related field or equivalent experience required. 3+ years of quality improvement, program management or project management experience required. Health care experience preferred
At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
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
