Manages physician contracting and network development for an assigned region. Responsible for developing, executing and maintaining a provider network strategy. Continuously evaluates network to ensure cost effective, optimal functionality. Works in concert with medical management and sales developing actions to meet market growth and medical cost targets.
Leads a team of Network Management Representatives and/or Specialists in developing, servicing and contracting providers.
Achieves company targets through aggressive IPA primary care, specialty and ancillary provider contracting and risk contract management.
Monitors primary care and specialty risk arrangements for Medicaid, and Medicare product lines.
Performs data analysis and develops specific actions to manage medical cost trend.
Assists in developing practices to assist risk partners in managing financial risk.
Identifies areas to improve provider service levels.
Educates/enhances relationships within the provider community.
Special projects as assigned or directed.
Required A Bachelor's Degree in a related field
Required or equivalent work experience in Network Development or Provider Relations
Required 5 years of experience in the healthcare sector (preferably at HMO or PPO)
Required 4 years of experience in HMO provider/hospital/ancillary contracting and network development
Required 1 year of management experience
Required Other Or 3 years of Supervisory, or Lead/Sr. role with demonstrated leadership ability or program management experience
Candidate Skills:Licenses and Certifications: A license in one of the following is required: Technical Skills:Languages:
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.