Sr Mgr, Hospital Contracting

Senior Manager, Hospital Contracting:
Oversees the network development and provider service functions for hospitals and selected ancillary providers within a state(s). Manages network staff responsible for contracting and provider relations. Works with finance, legal, medical management, sales, provider operations and provider service center personnel in developing actions to meet market growth and medical cost targets and excellent provider customer service .
Reports to: VP, Network Management
Department: Provider Relations
Position location: Manhattan, NY
Essential Functions:
  • Assists in developing a comprehensive network strategy to support market growth and medical cost targets
  • Negotiates and renegotiates contracts with assigned hospitals (and other providers as needed) to meet the goals of the state.
  • Prepares and execute periodic contract escalators/amendments and changes related to Medicare or Medicaid
  • Ensures all contracts/amendments meet regulatory guidelines for all products.
  • Verifies contract terms and demographics are loaded correctly in company databases.
  • Establishes effective departmental practices and work closely with various departments (finance, operations, legal, regulatory, sales, etc.) to ensure contracts meet operating, financial and legal standards.
  • Heavy emphasis on analyzing cost and utilization data to develop specific actions to manage medical cost trend.
  • Ensures compliance with Medicaid and Medicare for all contracting and network development purposes.
  • Performs provider education through in-service activities and regularly scheduled follow up with providers.
  • Ensure that providers receive provider and hospital communications ie: letters, newsletters, training materials, etc. to educate and enhance relationships with providers.
  • Creates and maintain strong relationships with internal and external contacts to support department goals.
  • Develops strategies to gain entry into new markets.
  • Manages a staff or hsopital contract and relations representatives.  
  • Performs other duties as assigned.
Education: A Bachelor's Degree in a related field or equivalent directly related experience.
Experience: 7 years of work experience in the healthcare sector (preferably at HMO, PPO, or hospital with focus on HMO provider/hospital/ancillary contracting. Knowledge of regulatory requirements concerning Medicare and Medicaid. 2 years performance management experience leading others.
Special Skills (e.g. 2nd language):
Strong oral and written communication skills sufficient to communicate clearly both complex and simple messages
Superior negotiating and customer service skills
Excellent analytical skills including ability to identify unusual variation in medical costs and to assess impact of change
Ability to work in a fast paced environment with changing priorities.
Ability to remain calm under pressure
Ability to organize tasks and work environment

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.