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

Network Management Representative - Senior Job

Full Job Title: Network Management Representative, Sr - Flagstaff, AZ

Job Number: 1802649

Location: Flagstaff, AZ

Date Posted: 5-25-2018

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.
DEPARTMENT: Provider Relations/Network Management
REPORTS TO: Manager, Network Management
Essential Functions:
  • Services, 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.
  • 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.
  • Bachelor's degree preferred or equivalent directly related Network Development or Provider Relations experience
  • 3 years experience in Provider Relations or Network Development required.
  • 3 years experience with managed care required.
  • Previous contracting experience 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.
Technical Skills:
  • Intermediate or stronger skill level with MS Word, Excel and Outlook required.
  • Beginner with MS PowerPoint helpful.

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Last Updated On: 12/9/2015