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

Network Management - Senior Manager Job

Full Job Title: Sr Manager, Network Management

Job Number: 1702579

Location: Chicago, IL

Date Posted: 7-13-2017

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.
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.
  • 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.
Candidate Education:
  • A Bachelor's Degree in a related field or equivalent related Network Development or Provider Relations experience.
Candidate 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.
Candidate Skills:
  • 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.
Technical Skills:
  • Intermediate proficiency in Microsoft Outlook, Word, and Excel required.

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Last Updated On: 12/9/2015