Remote
Position Purpose: Provide consultative support to providers to improve their 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.
Key Details: This is a field based position in the New York City area. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J -1, OPT, or CPT.
- Interpret performance data, prioritizing insights and developing discussion and presentation documents, including year-to-date results, month-over-month performance, and member engagement results.
- Facilitate provider discussions regarding quality, utilization, and cost or risk performance improvement opportunities, utilizing corporate tools and reporting.
- Collaborate with 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 the use of tools and interpretation of data.
- Present detailed HBR (Health Benefits Ratio) analysis and create reports for Joint Operating Committee meetings.
- Performs other duties as assigned.
- Complies with all policies and standards.
Education/Experience:
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.
For Fidelis Care NY Only: Valid state clinical license preferred (i.e.- LPN, RN, etc.).
Pay Range: $56,200.00 - $101,000.00 per year
At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
