Director, Materials Implementation (Remote)

Department: Operations

Reports to: Sr. Director Product

Location: Tampa FL or Remote

Executes strategies as appropriate to meet or exceed compliant clinical, operational and expansion efforts for a product within a specified state or region. Provides program leadership and development towards the growth and expansion of a product. Facilitates problem identification, solution development and initiative implementation to drive execution of program.

Essential Functions:

  • Manages, executes and directs the clinical and/or operational aspects of a specific product or program in a designated state.
  • Performs strategic planning and annual forecasting activities for specific product to achieve desired business results.
  • Builds or enhances relationships with providers and external partners to support company mission and create compliant opportunities for growth within the state.
  • Partners with operational team which includes analytics, enrollment, provider relations, quality improvement and authorization.
  • Assists in establishing effective clinical and/or operational practices and works closely with various health plan departments and regulatory agencies to ensure contracts meet clinical, operating, financial and legal standards.
  • Reviews data analysis and develops specific actions to manage medical cost trends.
  • Assists in developing practices to assist risk partners in managing financial risk.
  • Directs area activity to ensure compliance with regulatory and organizational requirements and standards.
  • Identifies areas to improve provider and member service levels within operating budget parameters.
  • Enhances relationships within the provider community, including community mental health centers, hospitals and individual providers and groups.
  • Assesses market dynamics, competitive position and operational performance.
  • Evaluates contracting and operational processes for "best practice" development across product.
  • Performs other duties as assigned
Additional Responsibilities:
    Candidate Education:
    • Required A Bachelor's Degree in Business Administration or a related field
    Candidate Experience:
    • Required 7 years of experience in strategic planning and development, product management, product operations, financial management or health care management
    • Required 4 years of management experience
    • Preferred 2 years of experience in managed care in a Payer, State Government agency, etc.
    Candidate Skills:
    • Advanced Demonstrated interpersonal/verbal communication skills
    • Advanced Demonstrated written communication skills
    • Intermediate Ability to work in a fast paced environment with changing priorities
    • Advanced Demonstrated organizational skills
    • Intermediate Demonstrated negotiation skills Ability to negotiate with a variety of stakeholders
    • Advanced Ability to analyze and interpret financial data in order to coordinate the preparation of financial records
    • Advanced Ability to analyze information and covert related activities into a comprehensive work plan
    • Advanced Ability to communicate and make recommendations to upper management
    • Advanced Ability to drive multiple projects
    • Advanced Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions
    • Intermediate Ability to implement process improvements
    • Advanced Demonstrated project management skills
    • Advanced Ability to lead/manage others in a matrixed environment
    • Advanced Ability to work within tight timeframes and meet strict deadlines
    • Advanced Demonstrated analytical skills
    • Advanced Demonstrated organizational skills
    • Advanced Knowledge of community, state and federal laws and resources
    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 PowerPoint
      • Required Intermediate Microsoft Outlook
      Languages:

        About us
        Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses exclusively on providing government-sponsored managed care services through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans to families, children, seniors and individuals with complex medical needs. WellCare is a Fortune 500 company, and in 2018, was recognized as a Fortune "World's Most Admired Company", ranking in the top five among the health insurance and managed care industry-a testament to the hard work and dedication of the company's nearly 9,000 associates who each day live WellCare's values and deliver on its mission to help its members live better, healthier lives. The company serves approximately 4.4 million members nationwide as of Dec. 31, 2017. 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.