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Provider Relations-Networking-Contracting WellCare - Provider Relations, Networking, & Contracting Leadership Careers

Network Management - Director Job

Full Job Title: Director, Network Management

Job Number: 1806448

Location: Field, NH

Date Posted: 2018-09-05

Department: Operations

Reports to: Medicare Executive Director

Location: New Hampshire

Directs a team in managing physician contracting, network development, provider relations and provider operations. Develops, executes and maintains a provider network strategy. Works in concert with medical management and sales to develop strategies to meet market growth and medical cost targets. Provides service and education to network physicians/providers.

Essential Functions:
  • Leads a team of department managers in developing and executing strategic departmental initiatives.
  • Achieves company targets through aggressive IPA primary care, specialty and ancillary provider contracting as well as risk contract management.
  • Manages required Hospital Contracting as appropriate.
  • 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.
  • Develops best practice to assist risk partners in managing financial risk.
  • Identifies areas to improve provider service levels.
  • Educates/enhances relationships within the provider community.
  • Manages Network integrity and compliance.
  • Manages claims projects as necessary/required.
  • Manages provider loads as necessary/required.
  • Special projects as assigned or directed.
Additional Responsibilities:
    Candidate Education:
    • Required A Bachelor's Degree in Business, Healthcare or related field
    • Required or equivalent work experience with directly related hospital and/or network contracting experience beyond the 5-7 years required
    • Preferred A Master's Degree in a related field
    Candidate Experience:
    • Required 7 years of experience in healthcare sector (preferably at HMO or PPO)
    • Required 5 years of experience in HMO provider/hospital/ancillary contracting and network development
    • Required 4 years of management experience
    Candidate Skills:
    • Intermediate Demonstrated organizational skills
    • Intermediate Demonstrated leadership skills Disciplined, hands-on and process-oriented leader
    • Advanced Other Knowledge of regulatory requirements concerning Medicare and Medicaid
    • Advanced Other Knowledge of provider contracts and health care reimbursement
    • Advanced 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
    • Advanced Other Ability to negotiate effectively with internal/external stakeholders, large hospital and physician healthcare systems
    Licenses and Certifications:
    A license in one of the following is required:
      Technical Skills:

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          Last Updated On: 12/9/2015