Assists with prioritizing corporate functions and focuses on producing revenue for the corporation through the effective coaching and developing of Representatives to build relationships and manage the accounts of their Providers.
DEPARTMENT: Provider Relations
REPORTS TO: Director, Network Management
- Leads and develops a team of Provider Relations Reps and Provider Ops Coordinators.
- Conducts ride-alongs with Reps in the field to develop skills and behaviors and document progress/provide formative feedback through timely and consistent Field Trip Reports.
- Conducts and directs provider contracting/negotiations and provider servicing.
- Performs data analysis and develops specific actions to manage medical cost trend.
- Assists in developing practices to assist risk partners in managing financial risk.
- Identifies areas to improve provider service levels.
- Educates/enhances relationships within the provider community.
- Assists in developing provider contracting and service.
- Strategizes for membership growth and retention.
- Performs special projects as assigned or directed.
This position is contingent upon the bid award in the state of Illinois to WellCare Health Plans, Inc.Candidate Education:
- A Bachelor's Degree in a related field preferred or equivalent work experience is required.
- 5 years of experience in Provider Relations or similar background required.
- 3 years of experience in Management, Supervisory, or Lead/Sr. role with demonstrated leadership ability or program management experience required.
- HMO/PPO background preferred.
- Intermediate - Ability to lead/manage others.
- Advanced - Demonstrated interpersonal/verbal communication skills.
- Advanced - Knowledge of healthcare delivery.
- Advanced - Functional and technical knowledge of healthcare delivery.
- Advanced - Ability to influence internal and external constituents.
- Advanced - Demonstrated analytical skills.
- Intermediate - Facilitative skills.
- Advanced - Financial skills.
- Advanced - Knowledge of CMS and state regulations.
- Advanced proficiency in Microsoft Outlook, Word, and Excel required.