Position Purpose: Oversee provider network to ensure appropriate access to care and quality member outcomes. Develop and implement activities for the recruitment and retention of effective providers. Partner with providers to monitor member health outcomes and oversee provider contract performance.
- Lead provider relations activities and oversee communications for providers.
- Evaluate the need for additional providers, programs and/or specialty treatment services for identified populations based on analyses of network gaps.
- Collaborate with all levels of the organization in order to verify accuracy of and analyze provider data to identify preferred practice patterns and provide further education to providers on integrated care, and network adequacy initiatives and expectations.
- Develop and monitor training and education materials; oversee new provider orientation to maximize performance in service delivery and contract compliance.
- Oversee the development all provider mentor and corrective action workflows and processes associated with provider performance.
- Develop and implement solution-focused strategies and tactics designed to increase provider compliance and improve provider performance.
- Bachelor's degree or equivalent experience in managed healthcare environment. Master's degree preferred.
- 6+ years of program development, network development, provider relations, or provider training experience.
- Claims and reimbursement system experience and provider business operations knowledge.
- In-depth knowledge of state compliance and regulatory processes/laws.
- License/Certification: Current state driver's license.
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.