Provider Performance Specialist II

Centene Corporation

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

Posted 9/17/2026full-timeNew York City • New York • United StatesJuniorMid-Level💰 $56,200 - $101,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in analyzing performance data and member engagement to drive quality improvement and cost management in healthcare. Proficient in utilizing corporate tools for reporting and presenting detailed analyses, including Health Benefits Ratio (HBR).

Highest-signal resume keywords

Performance Data InterpretationValue Based Performance (VBP) ToolsHealth Benefits Ratio (HBR) AnalysisManaged Healthcare ExperienceProvider Reimbursement Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data AnalysisPerformance ReportingClaims ProcessingUtilization ManagementCost Management

Soft Skills

Consultative SupportCollaborationCommunication

Tools & Technologies

Corporate Reporting ToolsData Interpretation Tools

Certifications & Qualifications

Valid State Clinical License

Industry Keywords

Managed CareProvider DiscussionsMember OutreachQuality ImprovementRisk 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, prioritize insights, and develop discussion and presentation documents
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

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
Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future
Valid state clinical license preferred for Fidelis Care NY only (i.e. LPN, RN, etc.)
Ability to interpret performance data and member engagement data
Ability to use corporate tools and reporting
Ability to develop proficiency in value based performance (VBP) tools
Ability to present detailed HBR (Health Benefits Ratio) analysis and create reports

Benefits

Comp & perks

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