*Network Management Rep, Sr - Prescott Valley

This position is for Care1st Health Plan, a WellCare Health Plans, Inc. company.

Department: Provider Relations -Medicaid

Reports to: Network Management Manager

Location: Prescott Valley, AZ

Job Type: Hourly/ Non-exempt

Manages physician contracting, network development and provider relations functions for developing, executing and maintaining a provider network strategy. Works in concert with medical management and sales developing actions to meet market growth and medical cost targets. Provides service and education to network physicians/providers.

Essential Functions:
  • Services, contracts and negotiates with primary care and specialty physicians and ancillary providers for all product lines.
  • Identifies network gaps and complete contracts.
  • Manages physician network by developing and maintaining relationships to drive business results within a specific geographic area.
  • Manages physician network by developing and maintaining relationships to drive business results within a specific geographic area.
  • Provides service and education to network physicians/providers.
  • Conducts site visits to service providers, resolve issues, educate staff/providers on policies, collect credentialing information, and review 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.

Education: Bachelor's degree preferred or equivalent directly related Network Development or Provider Relations experience
Experience: 3 years experience in Provider Relations or Network Development. 3 years experience with managed care. Previous contracting experience required.
Special Skills (e.g. 2nd language): Excellent influencing and negotiating skills. Ability to explain complicated financial terms and utilization data to physicians and staff. Excellent written skills. Excellent public speaking skills.

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.