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Provider Relations-Networking-Contracting WellCare - Provider Relations, Networking, & Contracting Leadership Careers

Director - Provider Network Operations Job

Full Job Title: Director, Provider Network Operations

Job Number: 1706146

Location: Baton Rouge, LA

Date Posted: 12-20-2017

The Director, Provider Network Operations Louisiana, will direct a team in managing physician contracting, network development, provider relations and provider operations. Develops, executes and maintains a provider network strategy. Works in concert with medical management and sales to develop strategies to meet market growth and medical cost targets. Provides service and education to network physicians/providers.

Key Duties and Responsibilities:

  • Leads a team of department managers in developing and executing strategic departmental initiatives.
  • Achieves company targets through aggressive IPA primary care, specialty and ancillary provider contracting as well as risk contract management.
  • Manages required Hospital Contracting as appropriate.
  • Monitors primary care and specialty risk arrangements for Medicaid, and Medicare product lines.
  • Performs data analysis and develops specific actions to manage medical cost trend.
  • Develops best practice to assist risk partners in managing financial risk.
  • Identifies areas to improve Provider service levels.
  • Educates/enhances relationships within the provider community.
  • Manages Provider Network integrity and compliance.
  • Manages claims projects as necessary/required.
  • Manages provider loads as necessary/required.
  • Special projects as assigned or directed.

Qualifications:

  • A Bachelor's Degree in Business, Healthcare or related field is required or equivalent work experience with directly related hospital and/or Provider Network contracting experience beyond the 5-7 years required
  • Master's Degree in a related field is preferred

Work Experience:

  • 7 years of experience in healthcare sector (preferably at HMO or PPO) is required
  • 5 years of experience in HMO provider/hospital/ancillary contracting and network development is required
  • 4 years of management experience is required
  • Personal computer experience should include working with Microsoft Word, Excel, PowerPoint and Outlook at the intermediate level at a minimum.

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Last Updated On: 12/9/2015