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: Assist with all vendor activity, including but not limited to dental, ancillary, pharmacy and vision vendors for the Health Plan.
Key Responsibilities:
- Assist with vendor utilization including workflows for coordinating services with the Health Plan.
- Analyze vendor data and complete required reports for the health plan, Corporate, and state.
- Perform as a key account manager for the Health Plan to coordinate with high priority providers and vendors.
- Coordinate with Medical Management, Member Services, and Provider Services to educate and communicate expectations, performance, and procedures to vendors.
- Respond to provider-related database information requests and concerns.
- Ensure operational integrity, including compliance with all policies and procedures for the Health Plan, including adherence to state contract and guidelines.
- Request and/or assist in the development of correction action plans for standards that are not met by the vendor.
- Serve as a point of contact and resource for the business unit and vendors for all credentialing inquiries and issues.
- Ensure compliance with NCQA, URAC, federal, state, and payor standards.
Highly Preferred:
- Advanced Excel skills - Pivot, VLOOKUP
- Project Management experience
- Data analytics or analysis experience
- 90% Remote and 10% Travel for vendor meetings, team meetings, and trainings.
- South FL Residents Highly Preferred
- Must reside in FL
Education/Experience:
Bachelor’s degree in Public Health, Business, related field or equivalent experience. 3+ years of healthcare management experience, preferably in vendor managed care or the health insurance field. Experience with reporting and analyzing data preferred. Strong Excel skills and working with a variety of software data programs preferred. Project management experience is a plus.
Pay Range:
$54,000.00 - $97,100.00 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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