What are the responsibilities and job description for the Network Performance Advisor - Now Hiring position at Superior HealthPlan?
You could be the one who changes everything for our 26 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
Essential Functions: * Owns and manages the relationship and performance of key provider groups.* Influences provider behaviors to drive improvements in provider & member satisfaction, optimizing member outcomes and maximizing shared savings.
* Drives improvement of provider performance by analyzing, interpreting and communicating financial, utilization and quality metrics.
* Establishes and leads cross-functional communication and collaboration with internal departments to support provider performance and resolve barriers and challenges.
* Serves as a primary liaison to providers on claim related content working with other departments for resolution.
* Responsible for understanding the differences between Risk and Value-Based contracting and driving improved provider performance.
* Plans, prepares, and executes effective group meetings/discussions with proper objectives and outcome.
* Responsible for understanding unique contract, quality, network requirements of Medicaid and Medicare.
* Responsible for understanding HEDIS and STARS measures and partner the Quality team to drive improved provider performance.
* Special projects as assigned or directed.Position Purpose: The Network Performance Advisor (NPA) serves as a key point of contact and liaison between assigned strategic providers and various departments within WellCare, including Quality, Operations, Finance, Health Services and other shared services departments. The NPA is responsible for ensuring white glove service to the providers. The NPA will develop and execute the strategy for their assigned providers, including building strong working relationship; building trust, maintaining high provider satisfaction and helping providers improve their performance. The Network Performance Advisor will be responsible for executing Network Transformation Strategies in order to manage overall network performance. The NPA will be responsible for the provider's overall performance. Candidate Education: Required A Bachelor's Degree in Health Care, Business, Finance or any other field
Required or equivalent work experience in Network Management/Network Development, Provider Relations, Risk and /or Value Base ContractingCandidate Experience: Required 5 years of experience in Network Management/Network Development, Provider Relations, Risk and/or Value Base Contracting, managed care organization
Required 2 years of experience in Account Management or management experience
Required Other Licenses and Certifications:A license in one of the following is required:
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
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.
