项目经理 II - 供应商网络
Program Manager II - Provider Network
职位职责：在俄勒冈州Trillium社区健康计划提供商合同团队中，您将作为主要业务负责人，负责Medicaid和Medicare业务线的提供商网络充足性监控、报告和战略网络分析。
关键信息：这是一个完全远程的职位。必须已获得在美国工作的授权，无需当前或未来任何基于雇佣的签证担保。此职位不提供任何类型的签证担保，包括H-1B、L-1、O-1、H-1B1、F-1、J-1、OPT或CPT。
- 按地区、专业和业务线进行常规和临时的提供商网络分析。
- 监控网络充足性表现，识别潜在差距和访问问题。
- 主持每月和每季度的网络充足性委员会（NAC）会议，并开发支持性报告材料。
- 通过与合同、提供商数据运营、提供商参与、认证、合规和网络运营团队的合作，管理网络缺口补救工作。
- 为内部管理层和监管要求准备网络充足性报告。
- 在适用情况下，支持年度Medicaid和Medicare网络充足性例外请求流程。
- 进行与合同谈判、终止和网络策略计划相关的提供商网络影响分析。
- 开发、维护和改进报告工具、仪表板、跟踪器、业务文档和流程工作流。
- 协调跨职能工作组，并确保行动项完成。
- 作为提供商网络构成、访问、充足性和报告方面的专家资源。
- 执行其他指派的任务。
- 遵守所有政策和标准。
优先技能：
- 具有医疗网络运营、提供商合同、网络充足性、提供商数据管理或管理护理组织的经验。
- 强大的分析和解决问题的能力，具有解读大型数据集并将其转化为可操作建议的经验。
- 高级Excel和报告能力，包括数据透视表、查找、数据验证和报告自动化。
- 使用Power BI、报告工具或商业智能平台的经验。
- 强大的项目管理和组织能力，能够同时处理多个优先事项。
查看英文原文
Position Purpose: Within our Oregon's Trillium Community Health Plan Provider Contracting team, you will serve as the primary business lead for provider network adequacy monitoring, reporting, and strategic network analysis across Medicaid and Medicare lines of business.
Key Details: This is a fully remote role. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.
- Conducting routine and ad hoc provider network analysis by geography, specialty, and line of business.
- Monitoring network adequacy performance and identifying potential gaps and access issues.
- Leading monthly and quarterly Network Adequacy Committee (NAC) meetings and developing supporting reporting materials.
- Managing network gap remediation efforts through collaboration with Contracting, Provider Data Operations, Provider Engagement, Credentialing, Compliance, and Network Operations teams.
- Preparing network adequacy reporting for internal leadership and regulatory requirements.
- Supporting annual Medicaid and Medicare network adequacy exception request processes when applicable.
- Performing provider network impact analyses related to contract negotiations, terminations, and network strategy initiatives.
- Developing, maintaining, and improving reporting tools, dashboards, trackers, business documentation, and process workflows.
- Coordinating cross-functional workgroups and ensuring action items are tracked through completion.
- Serving as a subject matter resource for provider network composition, access, adequacy, and reporting.
- Performs other duties as assigned.
- Complies with all policies and standards.
Preferred Skills:
- Experience with healthcare network operations, provider contracting, network adequacy, provider data management, or managed care organizations.
- Strong analytical and problem-solving skills with experience interpreting large data sets and transforming findings into actionable recommendations.
- Advanced Excel and reporting capabilities, including pivot tables, lookups, data validation, and reporting automation.
- Experience working with Power BI, reporting tools, or business intelligence platforms.
- Strong project management and organizational skills with the ability to manage multiple priorities simultaneously.
- Experience facilitating meetings and leading cross-functional workgroups.
- Excellent written and verbal communication skills.
- Ability to present data and recommendations to leaders and business stakeholders.
- Knowledge of Medicaid, Medicare Advantage, and Commercial network requirements is highly preferred.
- Experience with healthcare regulatory reporting, network adequacy standards, or provider network access analysis is strongly preferred.
Education/Experience: Bachelor's Degree in related field or equivalent experience required. 3+ years of quality improvement, program management or project management experience required. Health care experience preferred
Pay Range: $70,100.00 - $126,200.00 per year
At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
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
Originally posted on Himalayas