ProfessionalPosition Purpose: Coordinate and negotiate hospital, physician (IPAs, PPMs, individual providers, multi specialty groups) and ancillary service agreements that are in accordance with corporate, health plan and State guidelines.
Recruit and develop provider network plan for region and set of providers
Identify and initiate contact with potential providers
Leads assigned negotiations (i.e., hospital, physician and ancillary) and ensure that negotiations result in the unit cost targets expected and meet the objectives of the company and approximate the State's reimbursement to the provider
Facilitate and provide oversight to the provider set-up and contract configuration to ensure accurate claims adjudication
Evaluate and monitor providers' performance standards and financial performance of contracts.
Assist with and track credentialing activities
Facilitate the organization of provider focus groups
Coordinate with internal departments and contracted providers to implement and maintain contract compliance
May require up to 25% travel
Website : http://www.centene.com
Founded as a single health plan in 1984, Centene Corporation (Centene) has established itself as a national leader in the healthcare services field. Today, through a comprehensive portfolio of innovative solutions, we remain deeply committed to delivering results for our stakeholders: state governments, members, providers, uninsured individuals and families, and other healthcare and commercial organizations