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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: 1706187

Location: Richardson, TX

Date Posted: 1-10-2018

The Director, Provider Network Management Dallas, 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.
Candidate Education:
  • Required - A Bachelor's Degree in business, healthcare, or related fields or equivalent work experience with directly related hospital and/or Provider Networking contracting experience
  • Preferred - A Master's Degree in a related field
Candidate Experience:
  • Required - 7 years of experience in healthcare sector (preferably at an HMO or PPO)
  • Required - 4 years of experience in managing and leading others
Candidate Skills:
  • Ability to lead/manage others in a matrixed environment
  • Ability to influence internal and external constituents
  • Strong background in provider contracts, provider demographic data and/or other data management processes and oversight
  • Understanding of regulatory compliance management and reporting requirements for provider and network access information
  • Ability to analyze and interpret financial data in order to coordinate the preparation of financial records
  • Ability to analyze information and covert related activities into a comprehensive work plan
  • Ability to communicate and make recommendations to upper management
  • Ability to drive multiple projects
  • Ability to implement process improvements
  • Ability to represent the company with external constituents
Technical Skills:
  • Required - Intermediate proficiency working with Microsoft Word, Excel, PowerPoint and Outlook
  • Preferred - Ability to lead and manage large technical projects with time sensistive complex reporting requirements.

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Last Updated On: 12/9/2015