Manager, Network Administrator

The Mgr, Network Administration (NA) serves as a key point of contact and liaison between assigned strategic provider groups, IPA, LPOs and various departments within WellCare, including Quality, Operations, Finance, Health Services and other shared services departments. The Mgr, NA is responsible for ensuring white glove service to IPAs, LPOs and Boards assigned to them. The incumbent will develop and execute the strategy for their assigned providers, including building strong working relationships; building trust, maintaining high provider satisfaction and helping providers improve their overall performance. This role will also oversee a team of Provider Relations Representatives.

Reports To: Director, Network Management

Department: Provider Relations - Business & Network Development

Position Location: Houston, TX 77081

Essential Functions:

  • Manages the network for IPA's, primary care and specialty physicians and ancillary providers.
  • Achieves company targets through aggressive IPA primary care, specialty and ancillary provider contracting and risk contract management.
  • Manages physician network by developing and maintaining relationships to drive business results within a specific geographic area.
  • Manages the daily activities of 1 or more Provider Relations Representatives ensuring excellent service is being delivered to Providers.
  • Maintains relationships with IPA administrators and conducts on-site education meetings to ensure providers understand company policies and procedures (RAPS, service funds, cost reallocation, claim contestation).
  • Conducts site visits to service providers, resolves issues, educates staff/providers on policies, collects credentialing information, and reviews HEDIS information.
  • Supports regional Network Improvement Plan targets by providing utilization reports, pharmacy profiles, ER contingencies, Frequent Flier Reports and other analytics available to improve /maintain regions.
  • Manages incoming provider inquiries: identifies potential claims trends and follow-up with provider and internal departments to ensure that identified problems have been resolved.
  • Strategizes for membership growth and retention.
  • Special projects as assigned or directed.
Additional Responsibilities:
    Candidate Education:
    • Required A Bachelor's Degree in a related field Health Care, Business or Finance is preferred
    • Required or equivalent work experience in Network Management/Network Development, Provider Relations, Risk and/or Value Base Contracting
    Candidate Experience:
    • Preferred 3 years of experience in Network Management/Network Development, Provider Relations, Risk and/or Value Base Contracting, managed care organization
    • Required 2 years of experience in Account Management or management experience
    Candidate Skills:
    • Advanced Other Ability to establish and manage multi-disciplinary meeting approach with key provider groups
    • Advanced Other Ability to communicate and effectively influence provider's performance
    • Advanced Other Ability to operate as lead point of contract for key provider groups
    • Advanced Other Ability to build and maintain strong and long lasting partnerships with key provider groups
    • Advanced Other Ability to manage and work under pressure
    • Advanced Other Creates and maintains meaningful & proactive communication with provider groups
    • Advanced Other Manage provider's experience and satisfaction with health plan
    • Advanced Other Ability to forecast, track and monitor provider performance
    • Advanced Other Excellent cross-functional communication with internal departments (OAR, QPA, PHS, Field Finance)
    Licenses and Certifications:
    A license in one of the following is required:
      Technical Skills:
      • Required Advanced Microsoft Excel
      • Required Advanced Microsoft Outlook
      • Required Advanced Microsoft Word

        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 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.