Sr Mgr, Network Performance* (May reside anywhere in the US, travel required throughout designated region)

Provides strategic and operational leadership in the Network Performance and Strategy function. Plans and directs activities of the department and manages strategic initiatives to optimize WellCare's network management and provider engagement. Produces revenue for the corporation through the effective implementation of programs and processes to drive network performance.

*May reside anywhere in the United States. Heavy travel throughout region required.

Essential Functions:

  • Provides strategic and operational leadership for all functions within the network performance and strategy area.
  • Assists in the implementation of strategic initiatives relating to provider networks, including deployment of provider facing tools, new payment and incentive methods, risk arrangements and new engagement models.
  • Performs analysis of the provider performance relative to key Medicare and Medicaid metrics and support remediation plans as necessary in conjunction with the WellCare market provider team.
  • Participates and contributes to provider network data governance. Will act as the data steward for provider data that supports provider network strategy.
  • Provides leadership and direction for the efficient delivery of Enterprise Provider Dashboard, Episode Treatment Grouper, and other provider network related solutions.
  • Partners with operational leaders and IT to identify, assess, and prioritize meaningful opportunities to evolve applications in Network performance area, and to develop the people, processes, and technologies to achieve that objective.
  • Develops and implements new provider programs to improve overall provider performance, focused on cost and quality efficiency metrics
  • Communicates internally and externally regarding all provider related issues. Participate in key committees throughout the organization.
  • Continuously develops and implements new innovative process to support Network performance and strategy.
  • Supports implementation of processes and programs for new risk arrangements for providers.
  • Effectively communicates expectations and responsibilities to peers and cross functional teams. Actively listens and addresses issues and concerns promptly. Establishes a shared vision with project teams.
  • Supports provider relations activities where necessary including improvement efforts.
Additional Responsibilities:
  • Leads provider engagement (PR) initiatives by setting standards for provider relationships, assigning goals, measuring performance, creating and rolling out training for field based PR teams and maintaining processes for on-boarding new associates.
  • Collaborates with department leaders that support Provider Relations. E.g. Operations, Quality, Network Integrity etc.
  • Works in partnership with market network leaders and COOs to continuously develop their teams.
Candidate Education:
  • Required A Bachelor's Degree in a related field
Candidate Experience:
  • Required 6 years of experience in HealthCare or Managed Care
  • Required 3 years of experience in leading and/or managing others or managing processes and projects
  • Preferred Other Medicaid and/or Medicare
  • Preferred 3 years of experience in Working with physicians, providers, and/or medical practice office staff
Candidate Skills:
  • Intermediate Ability to lead/manage others
  • Advanced Knowledge of healthcare delivery
  • Advanced Demonstrated interpersonal/verbal communication skills
  • Intermediate Ability to influence internal and external constituents
  • Advanced Ability to effectively present information and respond to questions from peers and management
  • Intermediate Other Facilitative skills
  • Intermediate Other Knowledge of CMS and state regulations
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 Visio
    • Required Advanced Microsoft Word
    • Required Advanced Xcelys

    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.