This link will leave wellcare.com, opening in a new window. WellCare and its subsidiaries are not responsible for non-WellCare content, privacy practices, products or services described on these websites.
Manages physician contracting, network development and provider relations for developing, executing and maintaining a provider network strategy. Works in concert with medical management and sales developing actions to meet market growth and medical cost targets. Provides service and education to network physicians/providers.
Contracts and negotiates with primary care, specialty physicians and ancillary providers for all product lines in assigned markets.
Facilitates network growth by developing and maintaining relationships with non-participating providers to drive business results within a specific geographic area.
Identifies strategies to achieve Medical Expense Initiatives (MEI).
Performs ongoing research to identify new providers or areas of expansion in assigned market.
Responds to provider's contract requests and inquiries.
Analyzes network gaps and identifies providers to contract.
Reviews and amends provider's contracts when necessary.
Evaluates contracted network to ensure functionality.
Assesses performance and contract rates of providers to ensure our network is cost efficient.
Researches and develops relationships with non-contracted providers.
Collects credentialing and required documents for newly contracted providers.
Strategies for membership growth and retention.
Performs special projects as assigned
Required A Bachelor's Degree in a related field
Required or equivalent work experience directly related to Network Development or Provider Relations with demonstrated ability to perform the job duties
Required 2 years of experience in Provider Relations, Network Management, Hospital Contracting or related Provider Services position with demonstrated ability to perform the level of duties of the position
Required 1 year of experience in managed care
Required Other Previous contracting experience
Intermediate Demonstrated written communication skills
Intermediate Demonstrated negotiation skills
Intermediate Knowledge of healthcare delivery
Intermediate Demonstrated customer service skills
Intermediate Ability to represent the company with external constituents
Intermediate Demonstrated interpersonal/verbal communication skills
Intermediate Ability to multi-task
Intermediate Ability to analyze and interpret financial data in order to coordinate the preparation of financial records
Intermediate Ability to work independently
Intermediate Ability to work within tight timeframes and meet strict deadlines
Intermediate Demonstrated analytical skills
Intermediate Demonstrated organizational skills
Licenses and Certifications: A license in one of the following is required: Technical Skills: