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 relations. Serves as the single point of contact for all multi-state advanced partnerships with a focus on subject area as well as technical interfaces between the practices and the enterprise. Produces cost savings for the corporation through the effective implementation of processes to drive Network Performance.
Reports to: VP, Network Strategy & Provider Relations
Dept.: CNS Network Strategy
Location: Tampa, FL
- Provides strategic and operational leadership for all functions within the network performance and strategy area.
- Leads the development of strategic initiatives relating to provider networks, including service area expansions, new payment and incentive methods, risk arrangements and new products.
- Performs analysis of the provider performance relative to Medicare and Medicaid metrics and support remediation plans as necessary in conjunction with the WellCare market provider team.
- Develops and implements new provider programs to improve the delivery of services for members, which are high quality and cost effective for customers.
- Serves as the account manager for multi-state advanced partnerships providing subject matter and technical expertise to interactions between the practices and the enterprise.
- 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.
- Oversees implementation of processes and programs for new risk arrangements for providers.
- 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 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.
- 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 Relations (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 PR leaders and COOs to continuously develop their teams.
- Required A Bachelor's Degree in a related field
- Required 7 years of experience in HealthCare or Managed Care
- Required 5 years of experience in leading and/or managing others or managing processes and projects
- Preferred Other Medicaid and/or Medicare
- Advanced Ability to lead/manage others
- Advanced Knowledge of healthcare delivery
- Advanced Demonstrated interpersonal/verbal communication skills
- Advanced Ability to influence internal and external constituents
- Advanced Ability to effectively present information and respond to questions from peers and management
- Advanced Other Facilitative skills
- Intermediate Other Knowledge of CMS and state regulations
- Required Advanced Microsoft Excel
- Required Advanced Microsoft Outlook
- Required Advanced Microsoft Visio
- Required Advanced Microsoft Word
- Required Advanced Xcelys