Provider Performance Specialist II

🔥 13 hours ago

🗽 New York – Remote

🗽 New York – Remote

💵 $56.2k - $101k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Provide consultative support to providers to improve performance on member outreach, utilization management, cost, quality and risk • Discuss, analyze and interpret performance reporting, member engagement data and other data resources to identify opportunities for improving member outcomes • Interpret performance data and prioritize insights • Develop discussion and presentation documents, including year-to-date results, month-over-month performance and member engagement results • Facilitate provider discussions regarding quality, utilization, cost or risk performance improvement opportunities using corporate tools and reporting • Collaborate with the health plan quality counterpart to ensure coordinated communication and goal alignment for provider discussions • Develop proficiency in tools and value based performance (VBP) and educate providers on tool use and data interpretation • Present detailed HBR (Health Benefits Ratio) analysis and create reports for Joint Operating Committee meetings • Perform other duties as assigned • Comply with all policies and standards

🎯 Requirements

• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future • Bachelor’s degree in related field or equivalent experience • 2+ years of combined managed healthcare and provider reimbursement experience • Claims processing and/or managed care experience preferred • Valid state clinical license preferred for Fidelis Care NY only (e.g., LPN, RN)

🏖️ Benefits

• Competitive pay • Health insurance • 401K • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation