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.
- Manages the network for IPA's, primary care and specialty physicians and ancillary providers.
- Achieves company targets through aggressive IPA primary care, specialty and ancillary provider contracting and risk contract management.
- 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, resolves issues, educates staff/providers on policies, collects credentialing information, and reviews 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.
- 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 work experience directly related to Network Development or Provider Relations with demonstrated ability to perform the job duties required.
- 5 years of experience in Provider Relations, Network Management, Hospital Contracting or related Provider Services position with demonstrated ability to perform the level of duties of the position required.
- 3 year of experience in managed care required.
- IPA/Risk contracting experience required.
- Intermediate - Demonstrated written communication skills.
- Intermediate - Demonstrated negotiation skills.
- Intermediate - Knowledge of healthcare delivery.
- Intermediate - Demonstrated customer service skills.
- Intermediate - Ability to represent the company with external constituents.
- Intermediate - Demonstrated interpersonal/verbal communication 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 work independently.
- Intermediate - Ability to work within tight timeframes and meet strict deadlines.
- Intermediate - Demonstrated analytical skills.
- Intermediate - Demonstrated organizational skills.
- Intermediate proficiency in Microsoft Outlook, Word, and Excel required.