Job Description

Centene is transforming the health of our communities one person at a time. As an Executive on our team, you could be the one who changes everything for our 28 million members.

Work Location: Mechanicsburg, Philadelphia or Pittsburgh PA - in the office 2-3 days a week -possibly more some weeks.

This position has oversight of Provider Relations, Provider Data Management and Contracting.

Position Purpose: Direct the provider network and contracting activities. Lead all aspects of provider network strategy including, access analysis, network operations and support decision makers with analysis related to reimbursement and unit cost management. Oversee the coordination and negotiation for the contracting department.

• Establish the department's strategic vision, objectives, and policies and procedures.
• Develop, implement and maintain production and quality standards for the Contracting department.
• Oversee network development staff and external consultants in the development of provider networks across expansion markets.
• Perform periodic analyses of the provider network from a cost, coverage, and growth perspective. Provide leadership in evaluating opportunities to expand or change the network to meet Company goals.
• Manage budgeting and forecasting initiatives for product lines to networks costs and provider contracts.
• Oversee analysis of claim trend data and/or market information to derive conclusions to support contract negotiations.
• Conduct periodic review of provider contracting rates to ensure strategic focus is on target with overall Company strategy.
• Support market expansion and M&A activities by leading provider contract analysis related to due diligence.
• Assist health plan CEO and/or COO vendors in key provider relations and strategy.
• Ability to travel.

Education/Experience: Bachelor's degree or equivalent experience in Business Administration, Healthcare Administration or related field. MBA or MHA degree preferred. 10+ years of experience in managed care network development and provider relations/contracting management in a health care and/or managed care environment. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.

License/Certification: Valid driver's license. Pay Range: $170,300.00 - $323,300.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.

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.

by Jobble

Pennsylvania Health & Wellness

Job Tags

Holiday work, Contract work, Remote job, Flexible hours, 2 days per week, 3 days per week,

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