Director, Provider Relations

Strategizes for optimal business practices and efficiencies with an emphasis on producing revenue for the corporation. Position plans, provides resources and directs activities in network development, provider contracting/negotiation and provider service functions.

Essential Functions:

  • Sets goals for their area and works closely with Managers/Representatives to drive performance and to ensure provider satisfaction metrics are met or exceeded.
  • Conducts field rides with Provider Relations Representatives to gauge their performance and provide coaching and development in order to improve the business results.
  • Plans, conducts and directs provider contracting/negotiations and provider servicing.
  • Develops practices to assist risk partners in managing financial risk.
  • Performs data analysis and develops specific actions to manage medical cost trends.
  • Plans, provides resources and directs activities, network development, provider contracting/negotiation and provider service functions.
  • Develops provider contracting and service strategies and ensures maximum efficiencies in the utilization of human and financial resources.
  • Strategizes for membership growth, retention, and to affect sophisticated or complex provider relationships.
  • Provides proactive approach and support to emerging business activities established to remain competitive in the marketplace.
  • Maintains compliance for State and CMS audits.
  • Performs special projects as assigned or directed.

This position is contingent upon the bid award in the state of New Hampshire to WellCare Health Plans, Inc.

Candidate Education:
  • A Bachelor's Degree in a related field or equivalent work experience directly related to the level and duties of the job required.
Candidate Experience:
  • 7 years of experience in provider relations or similar background required.
  • 4 years of experience in management required.
Candidate Skills:
  • Intermediate - Demonstrated leadership skills
  • Intermediate - Ability to lead/manage others
  • Intermediate - Demonstrated interpersonal/verbal communication skills
  • Intermediate - Ability to influence internal and external constituents
  • Advanced - Demonstrated analytical skills
  • Advanced - Facilitative skills
  • Intermediate - Ability to convert related activities into a comprehensive work plan
  • Advanced - Financial skills
  • Advanced - Knowledge of CMS and state regulations
Technical Skills:
  • Intermediate proficiency in Microsoft Word and Excel required.

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.