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Provider Relations-Networking-Contracting WellCare - Provider & Hospital Contracting Careers

Network Management Specialist Job

Full Job Title: Network Management Specialist

Job Number: 1700459

Location: St Louis, MO

Date Posted: 4-27-2017

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.
DEPARTMENT: Network Management/Provider Relations
REPORTS TO: Manager, Network Management
Essential Functions:
  • 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

*LI-SM1

Education:
  • Bachelor's degree preferred or equivalent directly related Network Development or Provider Relations experience.
Experience:
  • 5 years experience in Provider Relations or Network Development.
  • 3 years experience with managed care.
  • IPA/Risk Contracting experience required.
Special Skills (e.g. 2nd language):
  • Excellent influencing and negotiating skills.
  • Ability to analyze and explain complicated financial terms and utilization data to physicians and staff.
  • Excellent written skills.
  • Excellent public speaking skills.

Technical Skills:

  • Intermediate or stronger skill level with MS Word, Excel, Outlook required.

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Last Updated On: 12/9/2015