Nov 14, 2019
WellCare Health Plans This position is contingent upon the bid award in the state of Ohio to WellCare Health Plans, Inc. Responsible for the overall operations of the health plan, including strategic direction, administration of all existing programs and development of new programs to ensure goals and objectives are met or exceeded. Working closely with the Division President and WellCare's executive leadership team, leads and directs overall operations including: provider contracting and relations, sales and marketing, medical management, regulatory compliance, government relations and finance, as well as interfacing with corporate office operations. May serve as the representative of the health plan to government entities and other external agencies. Ensures compliance with all relevant state and federal regulatory agencies, contracts and regulations. Reports to: SVP, Division PresidentDept.: Exec - StateLocation: Ohio Essential Functions: Leads and directs the day to day operations of the health plan. This includes providing leadership and direction to the management team to ensure the organization's strategic plan is translated into tactical goals and objectives that guarantee performance objectives are met or exceeded. Sets the tone from the top that compliance with all regulations and contract adherence is critical to WellCare success. Directs and manages the organization's financial performance. Takes appropriate actions to increase revenue, leverage resources, manage and/or minimize expenses. Directs the development of annual budgets and presents the budgets for approval. Assists and leads where appropriate, with aspects of state and federal government relationships, including working with regulators, as necessary, to establish and continue effective working relationships. Ensures that all state and federal regulations are met. Oversees the development and maintenance of a viable provider network to ensure the health care needs of WellCare members are met. Develops or manages provider contracts and partnerships to achieve quality and cost management objectives. Works closely with providers to enhance relationships and maximize their ability to effectively manage the cost of medical delivery. Oversees the development, implementation and continuous evaluation of the utilization and quality management program for medical services delivered by contracted health care providers. Oversees the development and implementation of short and long term sales and marketing plans. Leads organizational development activities that develop and foster strong working relationships among the members of the management team. Builds and promotes the culture of the plan to be consistent with the values established by the corporate office. Establishes formal and informal mechanisms to promote and maintain credibility, competence, and a positive corporate image by exhibiting strong communication to the corporate office, providers, members and committees. Develops new models and processes to meet future business needs Provides problem analysis and problem resolution at both a strategic and functional level Recommends and leads improvement processes and initiatives Performs other related duties as assigned by management Additional Responsibilities: Candidate Education: Required Bachelor's Degree in business administration, finance, healthcare administration or a related field Required or equivalent work experience directly related to the level, scope and primary duties of the roles and responsibilities of the position Preferred Master's Degree in a related field Candidate Experience: Required 5 years of experience in senior management with profit and loss accountability for a managed care organization Candidate Skills: Advanced Demonstrated leadership skills Intermediate Demonstrated ability to deal with confidential information Intermediate Demonstrated written communication skills Intermediate Demonstrated interpersonal/verbal communication skills Advanced Demonstrated organizational skills Intermediate Ability to work in a fast paced environment with changing priorities Intermediate Demonstrated problem solving skills Intermediate Other Ability to remain calm under pressure Intermediate Other Provides proactive approach and support to emerging business activities established to remain competitive in the marketplace Intermediate Other Proven ability to affect change and meet business goals, monitor progress and take corrective actions when necessary Intermediate Other Disciplined, hands on and process oriented leader who is not afraid of digging into details when necessary Intermediate Other A "failure is not an option" mentality and demonstrated proactive management style Intermediate Other Strong business acumen, intelligence and capacity. Thinks strategically and implements tactically Intermediate Other Ability to think creatively and out of the box Intermediate Other Comprehensive knowledge of delivery system operations, provider contracting, strategic planning and overall service delivery Technical Skills: Required Intermediate Microsoft Word Required Intermediate Microsoft Excel Required Intermediate Microsoft PowerPoint Required Intermediate Microsoft Outlook Required Intermediate Other Knowledge of and/or ability to utilize COGNOS for budgetary decisions or review 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 Columbus, OH, USA Full-Time