Acts as a strategic contributor to the state plan senior leadership team. Delivers on the development of a high quality, high performance network, drives a collaborative relationship with and between internal clinical and quality stakeholders and external provider partners, and improves the efficiency and quality of our cost structure through innovative value based purchasing strategies and care management approaches. Contributes to the broader platform of sustainable, profitable growth, has oversight of the provider network function, which includes network development, contracting, credentialing; provider relations, and provider services, coordinates project management across departments and ensures a comprehensive, cost effective, and accessible provider network.
- Develops and implements network contracting/expansion strategies specific to local markets in the assigned areas of coverage. This includes identifying and cultivating strategic alliances and building new network models with significant provider organizations to ensure that the health care needs of WellCare members are met.
- Provides strategic design and implementation of high performance networks to achieve quality and cost management objectives.
- Partners with internal resources (Health Services, Quality, Sales, etc.) to analyze medical trends in order to deliver high quality/large provider networks that support initiatives in achieving market growth and budgeted MLR costs.
- Partners with Corporate Compliance on policy administration for the provider networks and ensures contractual compliance with government regulations.
- Recognized as the department expert on contract negotiations and assists staff, as needed, during negotiation procedures with high volume provider groups.
- Provides senior leadership oversight for all provider services, including provider education and network management/provider relations support activities.
- Ensures that all provider support functions take a proactive approach to addressing emerging business activities in order to remain competitive within the marketplace.
- Performs other duties as assigned.
This position is contingent upon the bid award in the state of New Mexico to WellCare Health Plans, Inc.Candidate Education:
- A Bachelor's Degree in business administration, finance or a related field OR equivalent work experience required.
- A Master's Degree in a related field preferred.
- 10 years of experience in managed care organization required.
- 5 years of management experience with a proven track record of leadership experience in the health care industry required.
- Comprehensive knowledge of delivery system operations, provider contracting, strategic planning, and overall service delivery required.
- Powerful leadership skills with a vision and understanding of the future and subsequent changes required to meet business needs required.
- Proven ability to affect change and meet business goals, monitor progress and take corrective actions when necessary required.
- In-depth functional knowledge and broad based multi-functional knowledge required.
- In-depth understanding of company and customer needs required.
- Advanced - Ability to analyze information and covert related activities into a comprehensive work plan
- Advanced - Ability to represent the company with external constituents
- Advanced - Demonstrated leadership skills
- Advanced - Ability to effectively present information and respond to questions from peers and management
- Advanced - Ability to communicate and make recommendations to upper management
- Advanced - Demonstrated written communication skills
- Advanced - Demonstrated time management and priority setting skills
- Advanced - Demonstrated project management skills
- Advanced - Demonstrated negotiation skills
- Advanced - Ability to influence internal and external constituents
- Advanced - Demonstrated interpersonal/verbal communication skills
- Advanced - Ability to lead/manage others in a matrixed environment
- Intermediate proficiency in Microsoft Outlook, Word, Excel, and PowerPoint.