Care Manager, RN – PEDS
Centene Corporation
Provider Network Manager
Devoted Health
full-time
Posted on:
Location: Kentucky • 🇺🇸 United States
Visit company websiteSalary
💰 $80,000 - $100,000 per year
Job Level
Mid-LevelSenior
About the role
- Devoted Health mission: dramatically improve the health and well-being of older Americans by caring for every person like family
- Development, maintenance and management of an adequate provider network in assigned geographical area
- Maintaining relationships and all provider relations activities in assigned geographical area
- Negotiating and renegotiating contracts with providers as assigned
- Engage internal subject matter experts and providers to identify opportunities to improve provider/member cost and quality performance
- Monitoring of various reports to ensure all necessary compliance requirements are met and maintained
- Reporting to leadership current status, risks, and potential opportunities in area of responsibility on a regular basis
- Supporting the overall Network Team as required and supporting assigned groups to improve performance in CMS STAR measures
Requirements
- 5+ years negotiating provider contracts including physician / provider group contracts with multiple payment methodologies including value based/risk
- Provider servicing experience
- Solid ability to navigate either Google or MS Suite of products
- High School Diploma or equivalent minimum
- Experience in CMS STAR measures
- Experience and relationships in the local market
- Unrestricted driver's license to verify eligibility and capability for driving responsibilities
- Ability to make quick, independent decisions
- Mutually beneficial negotiation skills
- Strong project management skills
- Attention to detail
- Ability to analyze financial and performance reports and identify trends/variances
- Big Picture thinking and understanding impacts of decisions on network as a whole
- Extremely effective oral and written communication skills
