You could be the one who changes everything for our 28 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.
 

Position Purpose:  Design and implement initiatives to lower unit costs, improve quality outcomes, and reduce overall healthcare expenses, while overseeing the administration of Corporate Quality Provider Incentive Programs (P4P/P4Q). This role involves collaboration, utilizing data analytics, and optimizing care models to drive cost-effective, high-quality care delivery.

• Partner with various health plans to identify cost of care saving opportunities and execute plans to achieve targeted savings
• Research and analyze reimbursement methodologies for new and existing business opportunities for Medicaid, Commercial, Medicare, and other future products
• Develop and implement new payment innovation models such as quality incentive, gain sharing, risk sharing or bundled pricing models
• Identify technological solutions to implement alternative payment solutions to improve unit cost and contract performance
• Oversee the financial impact analysis and modeling for proposed value based and risk sharing programs and new payment innovation models such as bundled payments, capitation, etc.
• Create strategies for risk mitigation and contingency planning
• Develop reimbursement standards and policy to support Medicaid, Commercial, Medicare and other future products
• Develop key business rules, requirements and standards for implementation of new technological solutions and alternative payment solutions

Required Education/Experience: Bachelor’s degree in Business, Finance, Accounting, Healthcare Administration, or equivalent experience. 6+ years of combined managed care contracting, provider reimbursement and analysis, strategic planning or project management experience. Strong understanding of healthcare reimbursement and contracting methodologies from an operational and financial aspect.

Preferred Qualifications: Bachelor’s degree in Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work or equivalent experience.  5+ years of combined managed care, provider reimbursement and analysis, value based programs or project management experience.  Knowledge of HEDIS, NCQA, Medicare Star Rating System, QRS, or other quality measures. Knowledge of data mining, population health, and statistical modeling preferred; understanding of healthcare reimbursement and contracting methodologies from an operational and financial aspect preferred.

This position is open to someone working remotely anywhere in the Unites States. It may require out of state travel 1-2 times per year.

Pay Range: $103,500.00 - $191,600.00 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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act