Skip to main content
Provider Relations-Networking-Contracting WellCare - Provider Relations, Networking, & Contracting Leadership Careers

Network Management - Director Job

Full Job Title: Director Network Management

Job Number: 1803746

Location: Chicago, IL

Date Posted: 5-25-2018

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.

Reports to: VP, Field Network Management
Dept.: IL-PR-M'Caid-Cook
Location: Chicago, IL

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 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


Back to top

Join Our
Talent Network

and receive job alerts
Click Here
Last Updated On: 12/9/2015