Description
Position Purpose: Develop and maintain strategic partnerships between the health plan and contracted provider networks to advance value-based care initiatives, improve provider performance, and enhance member outcomes. Serve as a trusted advisor to providers and internal stakeholders by delivering data-driven insights, operational support, and performance improvement strategies. Contribute to network management, contracting, and value-based payment (VBP) program success through program administration, relationship management, analytics, education, and process optimization.
Key Details: For this role, we are only considering qualified applicants residing/currently living in Kentucky. 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.
- Serve as the primary strategic partner and point of contact for hospital systems, multispecialty groups, and large primary care organizations participating in value-based and risk-based arrangements.
- Act as the Value-Based Program (VBP) subject matter expert by providing guidance on program design, reporting tools, performance metrics, and financial methodologies.
- Deliver training, education, and ongoing support to provider organizations and health plan teammates to ensure proficiency with VBP programs, reporting, and operational processes.
- Manage and maintain the VBP contract portfolio by resolving operational issues, correcting data discrepancies, and supporting payment execution.
- Analyze and interpret complex datasets using Excel, dashboards, and reporting tools to identify performance trends, risks, and improvement opportunities.
- Develop and deliver executive-level presentations that translate provider performance data into actionable insights and recommendations.
- Drive VBP success through process improvement initiatives, operational efficiencies, and development of best-practice playbooks.
- Execute provider performance improvement strategies across VBPs, including quality, pay-for-performance (P4P), cost, and utilization initiatives, by evaluating performance, developing action plans, and monitoring progress toward established goals.
- Build and maintain strong relationships with provider leaders, executive stakeholders, and cross-functional internal teams.
- Support contracting strategy by providing insights on provider relationships, market dynamics, and organizational considerations that influence negotiations and performance outcomes.
- Review, interpret, and apply value-based and provider contract language to support operational execution and issue resolution.
- Educate providers on policies, procedures, claims submission requirements, referral processes, EDI capabilities, and provider portal tools.
- Provide leadership, guidance, and mentorship to provider-facing team members and external partners.
- Resolves provider issues as needed for resolution to internal partners and creating effeciencies to prevent continued concerns.
- Ability to travel locally 4 days a week, or as required.
- Perform other duties as assigned and maintain compliance with organizational policies, standards, and regulatory requirements.
Education/Experience:
- Bachelor’s degree in related field or equivalent experience. Master's Degree preferred in Public Health (MOH), Health Administration (MHA) or Business Administration (MBA).
- Five or more years of managed care or medical group experience, provider relations, quality improvement, utilization management, or clinical operations.
- Project management experience at a medical group, IPA, or health plan setting.
- Executive level exposure and ability to influence desired outcomes, innovation, performance, member improvements, growth and Provider retention.
- Ability to synthesize complex issues at multiple organizational levels, externally and internally across multi-disciplinary teams.
- Highly proficient in HEDIS/Quality measures, cost and utilization.
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
