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.
- 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.
- Performs special projects as assigned or directed.
This position is contingent upon the bid award in the state of Illinois to WellCare Health Plans, Inc.
- A Bachelor's Degree in a related field or equivalent related Network Development or Provider Relations experience.
- 7 years of relevant work experience in the healthcare sector, (preferably at HMO or PPO).
- 5 years experience in HMO provider/hospital/ancillary contracting and network development.
- 3 years progressively responsible managerial experience.
- Strong knowledge of regulatory requirements concerning Medicare and Medicaid.
- Knowledge of provider contracts and health care reimbursement.
- Advanced - Ability to speak publicly.
- Advanced - Demonstrated written communication skills.
- Advanced - Demonstrated negotiation skills.
- Advanced - Knowledge of healthcare delivery.
- Advanced - Demonstrated customer service skills.
- Advanced - Ability to represent the company with external constituents.
- Advanced - Demonstrated interpersonal/verbal communication skills.
- Advanced - Leadership skills.
- Intermediate - Ability to multi-task.
- Intermediate - Ability to analyze and interpret financial data in order to coordinate the preparation of financial records.
- Intermediate - Ability to explain complicated financial terms and utilization data to physicians and staff.
- Intermediate - Ability to analyze data to identify trends, and variance from goals.
Intermediate - Ability to manage complex transaction and service models.
Intermediate - Demonstrated proficiency in establishing and driving medical cost management programs.
Intermediate - Ability to negotiate effectively with internal/external stakeholders, large hospital and physician healthcare systems.
Intermediate - Ability to be an organized, disciplined, hands-on and process-oriented leader.
- Intermediate - Ability to work independently.
- Intermediate - Ability to work within tight timeframes and meet strict deadlines.
- Intermediate - Demonstrated analytical skills.
- Intermediate - Demonstrated organizational and time management skills.
- Intermediate proficiency in Microsoft Outlook, Word, and Excel required.