Senior Regional Provider Engagement Manager at Centene driving provider performance improvement strategies in healthcare. Engaging local markets and collaborating with leadership to enhance care outcomes.
Responsibilities
Provide hands-on Provider Engagement Operating Model (PEOM) support and guidance focused on coaching market teams to lead effective, data-driven provider performance conversations, including in-person performance enablement sessions, new hire performance immersion, and rollout of performance-focused initiatives and reporting.
Engage in Monthly and Quarterly PE Regional Leadership check-ins to review provider performance trends, prioritize high-impact provider groups, and align on corrective and growth strategies.
Lead new Provider Engagement implementations within assigned regions with an emphasis on performance measurement, standardized performance templates, reporting, and accountability frameworks.
Drive execution of key strategic initiatives that improve provider quality, cost performance, risk adjustment accuracy, pharmacy performance, and value-based outcomes across local markets.
Support development and execution of strategic operational plans tied directly to provider performance improvement, including large-scale performance transformation initiatives.
Collaborate with health plan leaders to support system-wide implementations that enable provider performance improvement, ensuring learnings transition from pilot to full-scale execution.
Drive and interpret provider performance KPIs, including quality, medical expense ratio (MER/HBR), risk adjustment, pharmacy measures, and value-based performance outcomes.
Utilize data analysis to identify provider performance gaps and develop targeted, measurable action plans to improve outcomes.
Support local market relationships by leading structured, outcome-oriented provider performance engagement with high-impact providers rather than routine provider servicing or issue resolution.
Partner with health plans and the enterprise Provider Experience team to monitor and improve provider performance in risk-based arrangements across multiple product lines.
Assist in driving provider-related corporate initiatives, strategies, and goals that advance enterprise-wide provider performance and value-based care objectives.
Analyze industry trends, provider performance models, and emerging technologies to enhance provider engagement strategies and performance outcomes.
Analyze and interpret provider performance data using research methods to inform strategic recommendations and provider action plans.
Prepare and deliver actionable performance insights through dashboards, presentations, and reports that directly support provider and market-level decision-making.
Escalate systemic performance barriers and risks that impede provider outcomes to ensure timely resolution and sustained performance improvement.
Enhance and leverage analytics, member demographics, and utilization patterns to identify provider efficiency opportunities and care delivery improvements.
Collaborate with operational teams and vendors to address structural or process-related barriers impacting provider performance—not to manage routine claims or provider inquiries.
Requirements
Bachelor's Degree health care administration, business, or related field or equivalent experience required
Master's Degree health care administration, business, or related field preferred
6+ years In provider engagement, network management, or healthcare strategy. required
In-depth knowledge of provider engagement, network management, and performance improvement methodologies required
Demonstrated track record of successfully leading cross-functional provider engagement teams and driving results in a dynamic environment required
Proven ability to influence senior leaders and manage complex initiatives.
Strong analytical skills with proficiency in interpreting performance metrics (HEDIS, STARs, risk adjustment, cost/utilization) required
Role requires roughly 50% local travel; mileage reimbursement will be issued.
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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