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Centene Corporation

Director PNM Operations

Centene Corporation - Rancho Cordova, CA

Description Position Purpose: The Director Provider Network Management Operations Western Region is responsible for developing, implementing, maintaining, and measuring an operational model that ensures compliance with accreditation, legislative and regulatory requirements, that supports organizational strategic initiatives and all Provider Network Management regions. Develops and drives uniformity, efficiencies and consistency in the areas of Provider Network Management. Ensures that Health Net is in compliance with federal, state and regulatory requirements in terms of provider-related issues, while promoting interdepartmental communication. Establishes and maintains strong relationships within divisions of Health Net to ensure that PNM activities are linked appropriately to relevant areas of the organization. Drives development of documented Provider Network Management policy and procedures. Designs associate and provider education plans, develops associate and provider communications, and assists in training Health Net associates, as necessary, in the various components of PNM strategy and initiatives. Facilitates and assists with problem resolution related to numerous entities including, but not limited to, providers, marketing, claims, member relations and employer groups. Performs management duties including, but not limited to, budgeting, performance management, staff development, coaching, training, staffing, disciplinary action, performance standards, and goals and objectives. Ensures that staff is adequately trained in all skills necessary and appropriate to their job, including but not limited to the following areas: contract administration, varying provider compliance requirements, software applications and programs to support compliance requirements, marketing programs, Health Net products, customer service, provider network management and project management. Consults with Organizational Effectiveness on human resources related issues, including but not limited to hiring process, conflict resolution, staff development, and performance evaluations. Qualifications Education\/Experience: Bachelor\u2019s degree required, or related field or equivalent health care experience; Master\u2019s degree preferred. Five to seven years extensive provider network management\/health care management experience. Strong project management experience plus previous supervisory\/management experience required. 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.

7 days 16 hours ago

Centene Corporation


Director PNM Operations Centene Corporation - Rancho Cordova, CA, United States


Location: Rancho Cordova, CA

Company Profile:
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