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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 Rep, Sr - Lake Havasu City

Job Number: 1803677

Location: Lake Havasu City, 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.

This position is forCare1st Health Plan, a WellCare Health Plans, Inc. company.

Department: AZ-PR-M'Caid State

Reports to: Network Management Manager

Location: Northern 4 Counties

Job Type: Salaried/ Exempt

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.
  • 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.
Education: Bachelor's degree preferred or equivalent directly related Network Development or Provider Relations experience
Experience: 3 years experience in Provider Relations or Network Development. 3 years experience with managed care. 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.

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Last Updated On: 12/9/2015