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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: 1703945

Alamogordo, NM
Valencia, NM
Roswell, NM
Clovis, NM
Santa FE, NM
Los Alamos, NM
Grants, NM
Bernalillo, NM
Mora, NM
Albuquerque, NM
San Miguel, NM
Taos, NM
Farmington, NM
Luna, NM
Hobbs, NM
Socorro, NM
Las Cruces, NM
South Valley, NM
Rio Rancho, NM
Statewide, NM

Date Posted: 12-13-2017

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 Mexico 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