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

Network Management - Manager Job

Full Job Title: Mgr, Network Management

Job Number: 1704604

Location: Asheville, NC

Date Posted: 10-13-2017

Manages physician contracting and network development for an assigned region. Responsible for developing, executing and maintaining a provider network strategy. Continuously evaluates network to ensure cost effective, optimal functionality. Works in concert with medical management and sales developing actions to meet market growth and medical cost targets.

Reports to: Director, Network Management

Location: North Carolina

Dept: Provider Relations

Essential Functions:

  • Leads a team of Network Management Representatives and/or Specialists in developing, servicing and contracting providers.
  • Achieves company targets through aggressive IPA primary care, specialty and ancillary provider contracting and risk contract management.
  • 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.
  • Assists in developing practices to assist risk partners in managing financial risk.
  • Identifies areas to improve provider service levels.
  • Educates/enhances relationships within the provider community.
  • Special projects as assigned or directed.
Additional Responsibilities:Candidate Education:
  • Required A Bachelor's Degree in a related field
  • Required or equivalent work experience in Network Development or Provider Relations
Candidate Experience:
  • Required 5 years of experience in the healthcare sector (preferably at HMO or PPO)
  • Required 4 years of experience in HMO provider/hospital/ancillary contracting and network development
  • Required 1 year of management experience
  • Required Other Or 3 years of Supervisory, or Lead/Sr. role with demonstrated leadership ability or program management experience
Candidate Skills:Licenses and Certifications:
A license in one of the following is required:
Technical Skills:Languages:

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Last Updated On: 12/9/2015