Account Executive developing strategic partnerships between health plans and providers at Centene. Ensuring delivery of high-quality care and executing performance improvement strategies for various provider networks.
Responsibilities
Develop strategic partnerships between the health plan and the contracted provider networks serving our communities
Cultivate client relations and collaborate with providers to ensure delivery of the highest level of care to our members
Participate in the development of network management strategies
Creates strategic initiatives for performance improvement
Serve as a strategic partner/primary contact for hospital systems, multi-specialty groups, and large PCP groups with Value Based/Risk Components
Executes provider performance improvement strategies in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc.
Builds strong interpersonal relationships with cross functional teams both externally (provider) and internally (health plan)-C-suite Level
Resolve provider issues as needed for resolution to internal partners and creating efficiencies to prevent continued concerns
Educate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics
Evaluates provider performance and develops strategic plan to improve performance
Present detailed HBR analysis and create reports for Joint Operating Committee meetings (JOC)
Acts as a lead for the external representatives
Coaches and trains external representatives
Ability to travel locally 4 days a week
Requirements
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
Highly proficient in HEDIS/Quality measures, cost and utilization
Benefits
competitive pay
health insurance
401K and stock purchase plans
tuition reimbursement
paid time off plus holidays
flexible approach to work with remote, hybrid, field or office work schedules
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