Oversees hospital and physician contracting in new states and expansion areas for Medicare and Medicaid. Negotiates complex, competitive contractual relationships with large health systems, including value based components. Develops and executes network development strategies with a sense of urgency to deliver timely results to support WellCare's growth targets. Position will also be engaged in RFP responses for new markets and may participate in provider network related due diligence activities for mergers and acquisitions.
Reports to: Sr. Director, National Contracting
Department: CNS-Network Strat&Optimization
Location: Tampa (Henderson Rd)
Ability to travel 25-50%
Tampa based or remote position
- Develops a comprehensive network strategy to support market growth and medical cost targets.
- Negotiates and renegotiates contracts with hospitals.
- Establishes effective departmental practices and work closely with various departments (operations, 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 government programs such as Medicaid and Medicare for all contracting and network development purposes.
- Identifies areas to improve provider service levels within operating budget parameters.
- Creates and distribute provider and hospital communications ie: letters, newsletters, training materials, etc. to educate and enhance relationships within the provider community.
- Perform other duties as assigned.
- Ability to travel by automobile, plane or other public transportation as necessary.
- Bachelor's level education or equivalent directly related experience; Master's Degree, strongly preferred
- 7 years work experience in the healthcare sector (preferably at HMO or PPO)
- 5 years experience in HMO provider/hospital/ancillary contracting and network development
- Knowledge of regulatory requirements concerning Medicare and Medicaid
- Strong knowledge of Microsoft Office including Outlook, Word, Excel and Access