Position Purpose: Build creditable and trusting relationships with stakeholders regarding performance metrics. Serve as liaison for the health plan to ensure that all the opportunities are highlighted through detailed reporting to the leadership at the groups. Individually own and lead HBR initiatives that ties to cost savings to the AOP for department. Serve as the clinical lead with large employer groups in the bid process.
Manage assigned departments or functions with an emphasis on execution, outcomes, continual improvement and performance enhancement.
Maintain relationships with key employer groups, physician groups, individual physicians, managed care organizations, and state medical associations and societies.
Participate in quality improvement programs to assure that members receive timely, appropriate, and accessible health care.
Provide ongoing compliance with standardized systems, policies, programs, procedures, and workflows.
Analyze member and population data to guide and manage program direction such as ensuring that members enroll in clinical programs indicated by their clinical need and monitor performance.
Participate in the administration of medical management programs to assure that network providers deliver and Plan members receive appropriate, high quality, cost effective care.
Assure compliance with all regulatory, accreditation, and internal requirements and audits.
Articulate plan policies and procedures to providers and organizations and works to ensure effective implementation of policies and programs.
May serve as a member on quality and/or care management programs and committees as directed.
Education/Experience: Graduate of an accredited medical school; Doctorate degree in Medicine and Surgery. MBA, MPH, or epidemiologist degree preferred. 5+ years of experience Managed care, experience with all LOBs, human resource, leadership capabilities; practice of medicine. 3+ years of supervisory/management experience
License/Certification: Current state’s MD license and specialty board certifications
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.
Internal Number: 1111515
About Health Net of California
Centene Corporation, a Fortune 500 company, is a diversified, multi-national healthcare enterprise that provides a portfolio of services to government sponsored healthcare programs, focusing on under-insured and uninsured individuals. Many receive benefits provided under Medicaid, including the State Children's Health Insurance Program (CHIP), as well as Aged, Blind or Disabled (ABD), Foster Care and Long Term Care (LTC), in addition to other state-sponsored/hybrid programs, and Medicare (Special Needs Plans). The Company operates local health plans and offers a range of health insurance solutions. It also contracts with other healthcare and commercial organizations to provide specialty services including behavioral health management, care management software, correctional healthcare services, dental benefits management, in-home health services, life and health management, managed vision, pharmacy benefits management, specialty pharmacy and telehealth services.