Healthcare Network Specialist
3 weeks ago
We are seeking a skilled Healthcare Network Specialist to join our team at Nebraska Total Care. As a key member of our organization, you will play a vital role in improving the quality and financial outcomes of our provider network.
Key Responsibilities- Conduct comprehensive provider orientations and ongoing educational outreach to enhance the business relationship between providers and the health plan.
- Educate providers on policies and procedures related to referrals, claims submission, credentialing documentation, and electronic data exchange.
- Investigate and resolve provider matters, ensuring timely and effective communication with account representatives.
- Engage providers in Patient-Centered Medical Home initiatives and promote quality improvement strategies.
- Analyze and report on Health Benefits Ratio (HBR) and Health Information Data Set (HEDIS) metrics to inform provider performance and improvement initiatives.
- Develop and communicate milestone documents, dashboards, and success metrics to stakeholders.
- Act as a liaison between providers and the health plan, fostering a collaborative environment to drive financial and quality performance.
- Provide information and status updates to providers regarding incentive agreements and performance metrics.
- Conduct site visits as needed to ensure compliance with policies and procedures.
- Perform other contracting duties as assigned, including recommending changes to pricing subsystems and submitting updates to provider-related database information.
To be successful in this role, you will need a Bachelor's degree in a related field or equivalent experience. A minimum of 2 years of combined managed healthcare and provider reimbursement experience is required, with claims processing and/or managed care experience being a plus. A current state driver's license is also necessary.
Candidates must reside in the state of Nebraska and be able to travel locally a minimum of 5 times per month.
Centene offers a comprehensive benefits package, including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off, and a flexible approach to work with remote, hybrid, field, or office work schedules.
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Healthcare Network Specialist
3 weeks ago
Omaha, Nebraska, United States Nebraska Total Care Full timeJob SummaryWe are seeking a skilled Healthcare Network Specialist to join our team at Nebraska Total Care. As a key member of our organization, you will play a vital role in improving the quality and financial outcomes of our provider network.Key ResponsibilitiesConduct comprehensive provider orientations and ongoing educational outreach to enhance the...
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Healthcare Network Specialist
3 weeks ago
Omaha, Nebraska, United States Nebraska Total Care Full timeJob SummaryWe are seeking a skilled Healthcare Network Specialist to join our team at Nebraska Total Care. As a key member of our organization, you will play a vital role in improving the quality and financial outcomes of our provider network.Key ResponsibilitiesConduct comprehensive provider orientations and ongoing educational outreach to enhance the...
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Oncology Nurse Specialist
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