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: Manages third party program relationships with Delegation partners for performance management standards, financial responsibility, and proactively implements appropriate business solutions as required. Acts as the critical link between our Delegation partners and internal Departments. As the company’s operations representative, this position manages the facilitation from initial launch of services through day-to-day interactions

• Serve as a key account manager for assigned vendors, ensuring effective communication, compliance with contracts, and optimal performance
• Vendors may include, but not limited to, dental, vision, non-emergent medical transport, flex cards, hearing and more
• Manage vendor utilization including work flows for coordinating services with the Health Plan and/or Operations Departments
• Provide and share monthly SLA performance dashboards and/or reporting with Delegated entity and address issues in performance of assigned SLA’s
• Request and/or assist in the development of correction action plans for standards that are not met by the vendor and implement correction action plans when necessary
• Track, analyze, and report on vendor performance and opportunities for improvement
• Create and manage vendor scorecard and associated ratings/correction plans
• Coordinate with Medical Management, Member Services, and Provider Services to educate and communicate expectations, performance and procedures to vendors
• Schedule and conduct monthly meetings with Delegated entities and document discussions, issues, attendees, and action items
• Research and resolve claim disputes with vendor, member or provider issues and route to appropriate person(s) for resolution
• Work closely with internal stakeholders to ensure vendors meet business needs and objectives
• Receive and respond to provider related database information requests and concerns
• Ensure operation integrity, including compliance with all policies and procedures for including adherence to state contract and guidelines
• Contribute to special projects and other planning initiatives that involve oversight of the Delegated Care Management entities
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience: Bachelor’s Degree Business Administration, Public Administration or related field or equivalent experience required. 5+ years supporting working with Primary Care Providers, Account Management experience working in Healthcare or related field, able to present to executive-level teams at the delegated entities required.

Pay Range: $68,700.00 - $123,700.00 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