Jan 24, 2020
WellCare Health Plans Do your best work. Live your best life. If you thrive in a fast-paced, growth-oriented environment, WellCare is the place for you. Our clinicians have the ability to guide, educate and support members facing a diverse set of health challenges. You will gain valuable experience as you positively affect the lives you touch every day. As a clinical professional on the WellCare team, you will enjoy many advantages, including competitive salaries, generous benefits, job stability, continuing education and all the resources you need to advance in your career. Manages provider Network performance for assigned territory with an account management approach. Achieves market performance targets through the implementation and execution of Network transformation strategies in order to improve the overall Network performance. Essential Functions: Owns and manages contractual relationship and performance of assigned in-network provider groups and leads communication efforts to assigned providers. Evaluates provider performance via Enterprise Provider Dashboard and develops performance action plans as needed. Completes new provider orientation for all applicable product lines to educate on policies and initiatives, resolve issues and educate staff/providers. In addition, drives adoption and utilization of RxEffect, P4Q, Medical Home, Cultural Competency, FWA, open/closed panels, ADA, PaySpan, ER overuse, etc. Establishes consistent and strong relationships with provider groups utilizing an account management approach. Establishes and leads cross-functional communication with internal departments. Collaborates with internal cross-functional team to support provider performance and resolve barriers and challenges. Drives improvement of provider performance by analyzing, interpreting and communication utilization and quality metrics. Understand and explains fee-for-service contracts, provides performance reports to drive and improve utilization and quality provider metrics. Understands fee-for-service contractual arrangement and works with internal support team to resolve provider contractual inquiries. Plans, prepares and executes effective group meetings/discussion with proper objectives and outcome with internal and external customers. Maintains provider data integrity including monitoring provider credentialing, location additions, demographic updates and terminations. Provides continual training to assigned providers on wellcare.com portal and other resources to assist with claims, authorizations, member benefits, etc. Provides oversight of delegated functions as applicable. Handles more complex and higher volume providers. Provides education, training and mentoring to newly hired or less experienced Provider Relations Representatives. Assists management on special projects and/or initiatives. Partners with Network Development to identify network gaps and suggests additional providers for recruitment to ensure network adequacy. Performs other special projects as assigned. Additional Responsibilities: Candidate Education: Required A Bachelor's Degree in a related field Required or equivalent work experience Candidate Experience: Required 3 years of experience in Provider Relations, Network Management, Hospital Contracting or related Provider Services position demonstrated ability to perform the level of duties of the position Required 1 year of experience in Medicaid/Medicare Candidate Skills: Intermediate Demonstrated interpersonal/verbal communication skills Intermediate Demonstrated written communication skills Intermediate Demonstrated negotiation skills Intermediate Demonstrated customer service skills Intermediate Knowledge of community, state and federal laws and resources Intermediate Ability to represent the company with external constituents Advanced Ability to multi-task Advanced Ability to work independently Advanced Demonstrated time management and priority setting skills Intermediate Other Ability to explain complicated financial terms and utilization data to physicians/staff Intermediate Other Ability to understand, interpret and communicate all types of provider and regulatory contracts Licenses and Certifications: A license in one of the following is required: Technical Skills: Required Intermediate Microsoft Word Required Intermediate Microsoft Excel Required Intermediate Microsoft Outlook 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.
Professional Diversity Network Bowling Green, KY, USA Full-Time