*Network Performance Advisor - Charlotte, North Carolina
Professional Diversity Network
Charlotte, NC, USA
WellCare Health Plans
The Network Performance Advisor (NPA) serves as a key point of contact and liaison between assigned strategic providers and various departments within WellCare, including Quality, Operations, Finance, Health Services and other shared services departments. The NPA is responsible for ensuring white glove service to the providers. The NPA will develop and execute the strategy for their assigned providers, including building strong working relationship; building trust, maintaining high provider satisfaction and helping providers improve their performance. The Network Performance Advisor will be responsible for executing Network Transformation Strategies in order to manage overall network performance. The NPA will be responsible for the provider's overall performance.
Department: Provider Relations
Location: Charlotte, NC
Reports To: VP Field Network Manager
Owns and manages the relationship and performance of key provider groups.
Influences provider behaviors to drive improvements in provider & member satisfaction, optimizing member outcomes and maximizing shared savings.
Drives improvement of provider performance by analyzing, interpreting and communicating financial, utilization and quality metrics.
Establishes and leads cross-functional communication and collaboration with internal departments to support provider performance and resolve barriers and challenges.
Responsible for understanding the differences between Risk and Value-Based contracting and driving improved provider performance.
Plans, prepares, and executes effective group meetings/discussions with proper objectives and outcome.
Responsible for understanding unique contract, quality, network requirements of Medicaid and Medicare.
Responsible for understanding HEDIS and STARS measures and partner the Quality team to drive improved provider performance.
Special projects as assigned or directed.
Required A Bachelor's Degree in Health Care, Business, Finance or any other field
Required or equivalent work experience in Network Management/Network Development, Provider Relations, Risk and /or Value Base Contracting
Required 5 years of experience in Network Management/Network Development, Provider Relations, Risk and/or Value Base Contracting, managed care organization
Required 2 years of experience in Account Management or management experience
Advanced Other Ability to establish and manage multi-disciplinary meeting approach with key provider groups
Advanced Other Ability to communicate and effectively influence provider's performance
Advanced Other Ability to operate as lead point of contact for key provider groups
Advanced Other Ability to build and maintain strong and long lasting partnerships with key provider groups
Intermediate Other Ability to manage and work under pressure
Advanced Other Creates and maintains meaningful & proactive communication with provider groups
Intermediate Other Manage Provider's experience and satisfaction with health plan
Advanced Other Ability to forecast, track, and monitor provider performance
Advanced Other Strong interpersonal skills that build rapport and trust with provider groups
Advanced Other Excellent cross-functional communication with internal departments (OAR, QPA, Case Management, Field Finance)
Licenses and Certifications: A license in one of the following is required: Technical Skills:
Required Advanced Microsoft Excel
Required Advanced Microsoft Outlook
Required Advanced Microsoft Word
About us Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.