Sr Director, Market Operations

Reports to: Executive Director Medicare

Location: 7100 Commerce Way Brentwood, TN 37027

Partners with Market Leadership to help set the strategy and drives the profitability of a suite of Medicare Markets. Incumbent provides oversight for network development, provider relations, marketing, sales and quality improvement. Provides leadership in all facets of the business including planning, assistance with the day to day management of state operations, project and initiative leadership, as well as organization development. This role will facilitate problem identification, solution development, initiative implementation as well as executing business strategies.

Essential Functions:

  • Provider overall operational support to a suite of Medicare markets regarding effective medical management, financial, compliance and quality through effective network contracting and long-term approach to successful partnerships with key providers.
  • Partners with Market Leadership to provide day-to-day leadership for network development, provider relations, marketing, sales and quality improvement.
  • Responsible for partnering with Medicare Executive Director to to establish and maintain key relationships with providers, hospitals, and community organizations.
  • Provides operational leadership for the development and maintenance of a viable provider network to ensure the health care needs of WellCare members. In conjunction with network leaders, develops and 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.
  • Provides operational leadership and support to SG&A planning and budgeting decision making for assigned markets.
  • Provides 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.
  • Leads change and executes on business objectives through oversight and management of key stakeholders and owners.
  • Monitors and manages key deliverables of the strategic plan.
  • Performs other duties as assigned.
Additional Responsibilities:
    Candidate Education:
    • Required A Bachelor's Degree in a related field with 10 years of directly related experience with 5 years of previous management experience.
    • Preferred A Master's Degree in a related field with 5 years of directly related experience with 3 to 5 years previous management experience
    • Preferred or equivalent work experience
    Candidate Experience:
    • Required 6 years of experience in managing a P&L in a health care environment; government programs and managed care experience
    • Required 5 years of management experience
    Candidate Skills:
    • Advanced Ability to lead/manage others
    • Advanced Ability to influence internal and external constituents
    • Advanced Ability to analyze and interpret financial data in order to coordinate the preparation of financial records
    • Advanced Ability to drive multiple projects
    • Advanced Ability to lead/manage others in a matrixed environment
    • Advanced Ability to represent the company with external constituents
    • Advanced Demonstrated analytical skills
    • Advanced Demonstrated interpersonal/verbal communication skills
    • Advanced Demonstrated leadership skills
    • Advanced Demonstrated negotiation skills
    • Advanced Knowledge of healthcare delivery
    • Advanced Other Extensive technical/functional expertise with strong management skills to coordinate broad function areas
    • Intermediate Other Ability to work both strategically and tactically to accomplish objectives
    Licenses and Certifications:
    A license in one of the following is required:
      Technical Skills:
      • Required Intermediate Microsoft Excel
      • Required Intermediate Microsoft Outlook
      • Required Intermediate Microsoft PowerPoint
      • Required Intermediate 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.