Provider Performance Specialist II

Centene Corporation

. Provide consultative support to providers to improve performance on member outreach, utilization management, cost, quality and risk .

Posted 9/23/2026full-timeRemote • New York • United StatesJuniorMid-Level💰 $56,200 - $101,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in performance analysis and provider engagement to enhance member outcomes, utilizing data interpretation and communication skills to drive quality and cost improvements in managed healthcare.

Highest-signal resume keywords

Managed Healthcare ExperienceProvider Reimbursement ExperienceClaims ProcessingData InterpretationPerformance Reporting

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Performance AnalysisUtilization ManagementCost ManagementQuality ImprovementMember Engagement

Soft Skills

Consultative SupportCollaborationFacilitationCommunication

Tools & Technologies

Value Based Performance ToolsHBR Analysis Tools

Certifications & Qualifications

Valid State Clinical License

Industry Keywords

HealthcareProvider DiscussionsJoint Operating CommitteeMember OutreachRisk Performance

About the role

Key responsibilities & impact

Provide consultative support to providers to improve performance on member outreach, utilization management, cost, quality and risk
Discuss, analyze and interpret performance reporting, member engagement data and other data resources to identify opportunities for improving member outcomes
Interpret performance data and prioritize insights
Develop discussion and presentation documents, including year-to-date results, month-over-month performance and member engagement results
Facilitate provider discussions regarding quality, utilization, cost or risk performance improvement opportunities using corporate tools and reporting
Collaborate with the health plan quality counterpart to ensure coordinated communication and goal alignment for provider discussions
Develop proficiency in tools and value based performance (VBP) and educate providers on tool use and data interpretation
Present detailed HBR (Health Benefits Ratio) analysis and create reports for Joint Operating Committee meetings
Perform other duties as assigned
Comply with all policies and standards

Requirements

What you’ll need

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future
Bachelor’s degree in related field or equivalent experience
2+ years of combined managed healthcare and provider reimbursement experience
Claims processing and/or managed care experience preferred
Valid state clinical license preferred for Fidelis Care NY only (e.g., LPN, RN)

Benefits

Comp & perks

Competitive pay
Health insurance
401K
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field or office work schedules
Additional forms of incentives may be included in total compensation