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

Network Integrity - Manager Job

Full Job Title: Manager, Network Integrity

Job Number: 1801024

Location: Tampa, FL

Date Posted: 3-2-2018

Location: Henderson Rd, Tampa, FL 33634

Department: Operations

Reports to: Sr. Manager, Network Integrity

Manages all activities to ensure adherence to network adequacy monitoring, provider data accuracy and assisting in delivering on Network Performance strategic efforts. Build strong relationships with key functional areas and Market Network Management and Provider Relations teams.

Essential Functions:

  • Oversees company-wide provider network adequacy monitoring.
  • Identify issues in geo-access reporting and state/CMS reporting; implement new standards.
  • Assists with synchronization efforts in HSD, Geo and Directories.
  • Manages and develops a team of Business Analysts. Directs work assignments, measures results and initiates personnel actions as required.project analysts. Directs work assignments, measures results and initiates personnel actions as required.
  • Establishes objectives, goals and performance measures for the function being managed.
  • Coordinates activities of the team to meet timelines.
  • Coordinates activities to ensure key deliverables are met and resolves conflicting demands.
  • Applies a comprehensive knowledge of WellCare policies and procedures related to provider network monitoring to the completion of assignments. Applies knowledge of regulatory requirements to the completion of assignments.
  • Develops relationships with business partners, including Network Development, Provider Relations, Configuration, Ancillary, Claims, etc.
  • Identify and remediate areas of potential improvement for responsible functions, drive change for accuracy and efficiency.
  • Assists in developing short range plans for overall departmental activities.
  • Assists in the implementation of programs and strategies within the department.
  • Assists management with recommendations on matters of policy and approve changes in area of expertise.
  • Manages regulatory reporting for provider network submissions and geo-access analyses.
  • Performs other duties as assigned.
Candidate Education:
  • Required: Bachelor's Degree in a related field, or equivalent work experience
Candidate Experience:
  • Required: 5 years of experience in provider and/or network data analysis
  • Required: 1 year of experience in supervising or leading others
  • Preferred: 3 years of experience in SQL, Access, advanced Excel, or related
Candidate Skills (e.g. 2nd language):
  • Demonstrated leadership skills
  • Ability to lead/manage others
  • Demonstrated analytical skills
  • Facilitative skills
  • Solid understanding of data analysis
Technical Skills:
  • Microsoft Access
  • Microsoft Excel
  • Microsoft Word
  • Microsoft PowerPoint
  • Microsoft Outlook

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Last Updated On: 12/9/2015