Director, Provider Payment Innovation, Provider Network Management

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, implement, and optimize innovative and value based payment contracting strategies to include the development of a broad vision, short and long term objectives and execution of key business initiatives across all products. Collaborate with multiple functional health plan departments to build out a strategic payment innovation roadmap. Using the newly developed roadmap, lead implementation of prioritized initiatives in partnership with Provider Network Management, Medical Management, Product, Claims, Sales and Marketing, Finance and Actuarial teams.

• Leads provider innovation, provider initiatives and network strategy, including network provider pricing and cost optimization, trend analysis and provider network improvement opportunities
• Leads the identification, development, work process design and implementation of new network provider innovation models
• Researches Federal, State and competitor strategies on value-based payments. Attend conferences and other events to ensure Health Net is fully aware of payment innovation efforts on all levels.
• Develops and implements provider network innovation and optimization standards and guidelines to increase market share, revenue growth, and quality outcomes
• Develops, implements and maintains a multi-year strategic roadmap for Health Net of California’s value-based payments strategy
• Leads a cross-functional team and work across the health plan to implement targeted initiatives (bundled payments, hospital quality incentives, shared risk redesign).
• Works with Covered California, IHA and other key stakeholders to understand and translate external strategies and requirements into internal implementation plans
• Collaborates with Networks team on payment innovation work and become the California health plan voice on various corporate committees and initiatives related to payment innovation strategy
• Oversees new provider innovation projects and program initiatives, including staff allocation, deliverables, milestones, and goals
• Identifies best practice and “center of excellence” opportunities and implement best practice approach to new providers through provider education

Required - Healthcare contract negotiation experience 

Extreme attention to detail

Remote position with occasional travel to Las Vegas, NV

Education/Experience: Bachelors’ degree in a related field or equivalent experience. Master’s degree preferred. 7+ years of contracting, network development, or provider network strategy or analysis experience in a healthcare or managed care environment. Experience in developing and executing multiyear roadmaps, evaluating various value based programs. Previous management experience including responsibilities for hiring, training, assigning work and managing the performance of staff. Project/Program management experience.

Licenses/Certifications: PMP Certification preferred.

Pay Range: $132,000.00 - $244,100.00 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

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