Vice President, Prospective Programs

🔥 0 minutes ago

🏰 Missouri – Remote

🏰 Missouri – Remote

💵 $188.9k - $359.8k / year

⏰ Full Time

🔴 Lead

👔 Vice President

👻 Ghost score 0%

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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

• Lead enterprise prospective risk adjustment strategy, operations, and governance across all lines of business • Oversee IHA vendor strategy and performance, including vendor selection, contract negotiation, capacity planning, outreach effectiveness, visit completion, claims submission, invoice accuracy, service-level performance, and issue resolution • Lead IOA vendor oversight and program strategy • Own CoC+ program strategy and execution, including program design, provider enablement, appointment agenda adoption, performance monitoring, and cross-functional coordination • Develop and execute provider education and CDI strategies to strengthen documentation quality and support accurate documentation of acuity • Oversee prospective program performance across provider-facing initiatives, assessment programs, documentation improvement efforts, and vendor partnerships • Establish performance measures, governance processes, and accountability frameworks • Partner with market, clinical, quality, provider engagement, finance, compliance, network, claims, and technology leaders • Provide enterprise leadership and accountability across lines of business, markets, vendors, provider groups, and functional partners • Advise executive leadership regarding prospective risk adjustment performance, opportunities, and enterprise priorities • Align contracts, resources, reporting, and program priorities with Procurement, Vendor Management, Finance, Claims, Compliance, Quality, local market teams, Provider Engagement, and Technology • Perform other duties as assigned and comply with all policies and standards

🎯 Requirements

• Bachelor's Degree in healthcare administration, business, clinical discipline, health information management, finance, analytics or related field required • 10+ years of progressive healthcare leadership experience, including risk adjustment, provider engagement, clinical documentation improvement, quality or related healthcare operations required • Experience leading enterprise programs across multiple markets and lines of business (Medicare, Marketplace, Medicaid) required • Demonstrated success leading strategic initiatives, provider-facing programs, vendor partnerships, and cross-functional teams required • Experience managing vendor strategy and performance, including contract compliance, service delivery, financial reconciliation, and corrective action initiatives required • Strong knowledge of risk adjustment methodologies, healthcare operations, provider documentation, and regulatory requirements required • Proven executive leadership, communication, and stakeholder management skills required • Equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position

🏖️ Benefits

• Competitive pay • Health insurance • 401K plan • 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