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Provider Relations-Networking-Contracting WellCare - Provider Relations, Networking, & Contracting Leadership Careers

Provider Relations - Director Job

Full Job Title: Director, Provider Relations

Job Number: 1803486

Location: Concord, NH

Date Posted: 2018-08-23

Strategizes for optimal business practices and efficiencies with an emphasis on producing revenue for the corporation. Position plans, provides resources and directs activities in network development, provider contracting/negotiation and provider service functions.

Essential Functions:

  • Sets goals for their area and works closely with Managers/Representatives to drive performance and to ensure provider satisfaction metrics are met or exceeded.
  • Conducts field rides with Provider Relations Representatives to gauge their performance and provide coaching and development in order to improve the business results.
  • Plans, conducts and directs provider contracting/negotiations and provider servicing.
  • Develops practices to assist risk partners in managing financial risk.
  • Performs data analysis and develops specific actions to manage medical cost trends.
  • Plans, provides resources and directs activities, network development, provider contracting/negotiation and provider service functions.
  • Develops provider contracting and service strategies and ensures maximum efficiencies in the utilization of human and financial resources.
  • Strategizes for membership growth, retention, and to affect sophisticated or complex provider relationships.
  • Provides proactive approach and support to emerging business activities established to remain competitive in the marketplace.
  • Maintains compliance for State and CMS audits.
  • Performs special projects as assigned or directed.

This position is contingent upon the bid award in the state of New Hampshire to WellCare Health Plans, Inc.

Candidate Education:
  • A Bachelor's Degree in a related field or equivalent work experience directly related to the level and duties of the job required.
Candidate Experience:
  • 7 years of experience in provider relations or similar background required.
  • 4 years of experience in management required.
Candidate Skills:
  • Intermediate - Demonstrated leadership skills
  • Intermediate - Ability to lead/manage others
  • Intermediate - Demonstrated interpersonal/verbal communication skills
  • Intermediate - Ability to influence internal and external constituents
  • Advanced - Demonstrated analytical skills
  • Advanced - Facilitative skills
  • Intermediate - Ability to convert related activities into a comprehensive work plan
  • Advanced - Financial skills
  • Advanced - Knowledge of CMS and state regulations
Technical Skills:
  • Intermediate proficiency in Microsoft Word and Excel required.

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Last Updated On: 12/9/2015