Sr. Director, MLTC Operations

Executes and develops strategies to meet or exceed compliant operation of the MLTC, MAP and potential expansion LTC markets. Oversees provider contracting and network management as it relates to LTC operations. Provides support with project and initiative leadership, as well as organizational development. Facilitates problem identification, solution development and initiative implementation on behalf of, or in conjunction with, MLTC senior leadership. Acts as a deployable resource to provide increased initiative bandwidth while developing depth and succession planning in the leadership ranks for the product.

Essential Functions:
  • Accountable for the management and execution of special projects that may interface across multiple functional areas, and liaise with external constituents as needed to build relationships or deliver results.
  • Leads and directs the operational aspects of the LTC plans. Responsible for achieving business results as directed by state leadership.
  • Develops and implements annual provider contracting initiatives to achieve access, quality and cost management objectives.
  • Performs strategic planning and annual forecasting activities for MLTC. Has accountability for assessing market dynamics, competitive position and operational performance Builds or enhances relationships with providers and community based partners to support WellCare's mission and create compliant opportunities for growth within the state.
  • Takes the appropriate actions to ensure compliance within all areas of the business for which there is accountability.
  • Evaluates sales, contracting and operational processes for "best practice" development across MLTC plan.
  • Oversees and manages the operation team which includes analytics, enrollment, provider relations and authorization.
  • Performs other duties as assigned.
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 in business administration required.
Candidate Experience:
  • 10 years of experience in strategic planning and development, provider contracting, and financial management required.
Candidate Skills:
  • Intermediate - Ability to lead/manage others
  • Intermediate - Ability to work as part of a team
  • Intermediate - Demonstrated interpersonal/verbal communication skills
  • Intermediate - Ability to work in a matrixed environment
  • Intermediate - Demonstrated analytical skills
  • Intermediate - Analytical with an ability to drive change.
  • Intermediate - Must be able to effectively maintain/build relationships across business and/or functional areas
  • Intermediate - Adaptable
  • Intermediate - Demonstrated contributor in a health care or managed care environment
Technical Skills:
  • Intermediate proficiency with Microsoft Outlook, Word, Excel, and PowerPoint.
  • Intermediate experience with quantitative analysis and financial modeling capability required.

About us
Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. 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.