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.
- 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.
- 7 years of experience in provider relations or similar background required.
- 4 years of experience in management required.
- 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
- Intermediate proficiency in Microsoft Word and Excel required.