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Provider Relations-Networking-Contracting WellCare - PR & Contracting Management Careers

Network Contracting - Senior Manager Job

Full Job Title: Sr. Manager, Network Contracting

Job Number: 1703962

Location: Columbia, SC

Date Posted: 8-28-2017

Manages physician contracting and network development for an assigned region. Responsible for developing, executing and maintaining a provider network strategy. Continuously evaluates network to ensure cost effective, optimal functionality. Works in concert with medical management and sales developing actions to meet market growth and medical cost targets.

Reports To: Sr., Director, Network Management

Department: Network Management

Position Location: Columbia, SC 29210


Essential Functions:

  • Leads a team of Network Management Representatives and/or Specialists in developing, servicing and contracting providers.
  • Achieves company targets through aggressive IPA primary care, specialty and ancillary provider contracting and risk contract management.
  • 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.
  • Assists in developing practices to assist risk partners in managing financial risk.
  • Identifies areas to improve provider service levels.
  • Educates/enhances relationships within the provider community.
  • Special projects as assigned or directed.

#LI-Wellcare

Candidate Education:
  • Required A Bachelor's Degree in a related field
  • Required or equivalent work experience Network Development or Provider Relations
Candidate Experience:
  • Required 6 years of experience in the healthcare sector (preferably at HMO or PPO)
  • Required 5 years of experience in HMO provider/hospital/ancillary contracting and network development
  • Required 3 years of management experience
Candidate Skills:
  • Intermediate Demonstrated organizational skills
  • Intermediate Ability to influence internal and external constituents
  • Advanced Ability to represent the company with external constituents
  • Advanced Demonstrated negotiation skills
  • Advanced Knowledge of community, state and federal laws and resources
  • Advanced Knowledge of healthcare delivery
  • Demonstrated interpersonal/verbal communication skills
  • Demonstrated leadership skills
  • Intermediate Other Knowledge of provider contracts and health care reimbursement
  • Intermediate Other Understanding of regulatory compliance management and reporting requirements
  • Intermediate Other Ability to manage complex transaction and service models
  • Intermediate Other Demonstrated proficiency in establishing and driving medical cost management programs
  • Intermediate Other Disciplined, hands-on and process-oriented leader
Licenses and Certifications:
A license in one of the following is required:
Technical Skills:
  • Required Intermediate Microsoft Outlook
  • Required Intermediate Microsoft Excel
  • Required Intermediate Microsoft Word
Languages:

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Last Updated On: 12/9/2015