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Provider Relations-Networking-Contracting WellCare - Provider Administration & Support Careers

Network Development Representative - Senior Job

Full Job Title: Network Development Representative, Sr.

Job Number: 1702924

Location: Little Rock, AR

Date Posted: 7-13-2017

Manages physician contracting, network development and provider relations functions 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.

REPORTS TO: DIRECTOR, PRODUCT OPERATIONS
DEPARTMENT: TN OPERATIONS STATE
POSITION LOCATION: LITTLE ROCK, AR 72207
Essential Functions:
  • Contracts and negotiates with primary care and specialty physicians and ancillary providers for all product lines.
  • Identifies network gaps and complete contracts.
  • Manages physician network by developing and maintaining relationships to drive business results within a specific geographic area.
  • Manages physician network by developing and maintaining relationships to drive business results within a specific geographic area.
  • Provides service and education to network physicians/providers.
  • Conducts site visits to service providers, resolve issues, educate staff/providers on policies, collect credentialing information, and review HEDIS information.
  • Supports regional Network Improvement Plan targets by providing utilization reports, pharmacy profiles, ER contingencies, Frequent Flier Reports and other analytics available to improve/maintain regions.
  • Manages incoming provider inquiries: identifies potential claims trends and follow-up with provider and internal departments to ensure that identified problems have been resolved.
  • Strategizes for membership growth and retention.
Education:
  • Bachelor's degree preferred or equivalent directly related Network Development or Provider Relations experience is required
Experience:
  • 3 years experience in Provider Relations or Network Development is required
  • Medicare Advantage experience is required
  • 3 years experience with managed care is required
  • Previous contracting experience required is required
Special Skills (e.g. 2nd language):
  • Excellent influencing and negotiating skills
  • Ability to explain complicated financial terms and utilization data to physicians and staff
  • Excellent written skills
  • Excellent public speaking skills *LI-RG1


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Last Updated On: 12/9/2015