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Provides strategic and operational leadership in the Network Performance and Strategy function. Plans and directs activities of the department and manages strategic initiatives to optimize WellCare's network management and provider engagement. Produces revenue for the corporation through the effective implementation of programs and processes to drive network performance.
Provides strategic and operational leadership for all functions within the network performance and strategy area.
Assists in the implementation of strategic initiatives relating to provider networks, including deployment of provider facing tools, new payment and incentive methods, risk arrangements and new engagement models.
Performs analysis of the provider performance relative to key Medicare and Medicaid metrics and support remediation plans as necessary in conjunction with the WellCare market provider team.
Participates and contributes to provider network data governance. Will act as the data steward for provider data that supports provider network strategy.
Provides leadership and direction for the efficient delivery of Enterprise Provider Dashboard, Episode Treatment Grouper, and other provider network related solutions.
Partners with operational leaders and IT to identify, assess, and prioritize meaningful opportunities to evolve applications in Network performance area, and to develop the people, processes, and technologies to achieve that objective.
Develops and implements new provider programs to improve overall provider performance, focused on cost and quality efficiency metrics
Communicates internally and externally regarding all provider related issues. Participate in key committees throughout the organization.
Continuously develops and implements new innovative process to support Network performance and strategy.
Supports implementation of processes and programs for new risk arrangements for providers.
Effectively communicates expectations and responsibilities to peers and cross functional teams. Actively listens and addresses issues and concerns promptly. Establishes a shared vision with project teams.
Supports provider relations activities where necessary including improvement efforts.
Leads provider engagement (PR) initiatives by setting standards for provider relationships, assigning goals, measuring performance, creating and rolling out training for field based PR teams and maintaining processes for on-boarding new associates.
Collaborates with department leaders that support Provider Relations. E.g. Operations, Quality, Network Integrity etc.
Works in partnership with market network leaders and COOs to continuously develop their teams.
Required A Bachelor's Degree in a related field
Required 6 years of experience in HealthCare or Managed Care
Required 3 years of experience in leading and/or managing others or managing processes and projects
Preferred Other Medicaid and/or Medicare
Preferred 3 years of experience in Working with physicians, providers, and/or medical practice office staff
Intermediate Ability to lead/manage others
Advanced Knowledge of healthcare delivery
Advanced Demonstrated interpersonal/verbal communication skills
Intermediate Ability to influence internal and external constituents
Advanced Ability to effectively present information and respond to questions from peers and management
Intermediate Other Facilitative skills
Intermediate Other Knowledge of CMS and state regulations
Licenses and Certifications: A license in one of the following is required: