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

Network Management - Senior Director Job

Full Job Title: Sr. Director Network Management

Job Number: 1703951

Alamogordo, NM
Valencia, NM
Roswell, NM
Clovis, NM
Santa FE, NM
Los Alamos, NM
Grants, NM
Bernalillo, NM
Mora, NM
Albuquerque, NM
San Miguel, NM
Taos, NM
Farmington, NM
Luna, NM
Hobbs, NM
Socorro, NM
Las Cruces, NM
South Valley, NM
Rio Rancho, NM
Statewide, NM

Date Posted: 12-13-2017

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.

This position is contingent upon the bid award in the state of New Mexico to WellCare Health Plans, Inc.*LI-SM1

  • A Bachelor's Degree in Business, Healthcare or related field required.
  • A Master's Degree in a related field preferred.
  • 10 years of experience in healthcare sector (preferably at HMO or PPO) required.
  • 7 years of experience in HMO provider/hospital/ancillary contracting and network development required.
  • 5 years of management experience required.

Special Skills:

  • Demonstrated organizational skills.
  • Demonstrated leadership skills.
  • Disciplined, hands-on and process-oriented leader.
  • Knowledge of regulatory requirements concerning Medicare and Medicaid.
  • Knowledge of provider contracts and health care reimbursement.
  • Understanding of regulatory compliance management and reporting requirements.
  • Ability to manage complex transaction and service models.
  • Demonstrated proficiency in establishing and driving medical cost management programs.
  • Ability to negotiate effectively with internal/external stakeholders, large hospital and physician healthcare systems.

Technical Skills:

  • Intermediate proficiency in Microsoft Outlook, Word, Excel and PowerPoint.
  • Knowledge of and/or ability to utilize a budgetary software application.

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Last Updated On: 12/9/2015