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Compliance & Regulatory WellCare - Compliance & Regulatory Leadership Careers

Risk Provider Management - Director Job

Full Job Title: Director Risk Provider Management

Job Number: 1802421

Location: Tampa, FL

Date Posted: 2018-07-11

LOCATION: Rocky Point, Tampa, FL
DEPARTMENT: FL Market - Network Development
REPORTING TO: VP, Field Network Management

Leads the strategic development, implementation and management of the Managed Services Organization (MSO) for a given market(s) Manages risk provider contracting, network development and provider service functions for a given market(s). Works in concert with a variety of corporate support partners as well as the network development team in determining and enacting strategy to meet market growth, quality and associated required medical cost targets.

Essential Functions:

  • Oversees the development, implementation and management of a Management Services Organization (MSO).
  • Manages all contracting for state wide risk providers (IPAs).
  • Builds a comprehensive network strategy to support the risk provider/IPA network, managed medical costs and quality targets.
  • Negotiates managed care contracts with physicians, hospitals, and ancillary services on a risk basis that will meet network adequacy and marketability needs.
  • Establishes effective departmental practices and works closely with various departments (operations, regulatory, local market, legal, sales, etc.) to ensure the network and the contracts meet operating, financial, compliance and legal standards.
  • Develops practices to educate and assist risk partners in managing financial risk.
  • Assist in the hiring and initial training of local market contracting and provider services.
  • Ensures compliance with government programs such as Medicaid and Medicare for all risk contracting and network development purposes.
  • Performs other duties as assigned.
Additional Responsibilities:

    Candidate Education:
    • Required A Bachelor's Degree in a related field
    • Preferred A Master's Degree in a related field
    Candidate Experience:
    • Required 7 years of experience in managed care contracting
    • Required 5 years of experience in targeted experience with Risk Providers and IPA Management
    • Required 5 years of management experience with oversight of remote and/or matrixed teams
    • Preferred Other Experience in network development for Medicare or Medicaid
    Candidate Skills:
    • Intermediate Ability to analyze and interpret financial data in order to coordinate the preparation of financial records
    • Intermediate Ability to effectively present information and respond to questions from peers and management
    • Intermediate Ability to work in a fast paced environment with changing priorities
    • Intermediate Ability to implement process improvements
    • Intermediate Ability to represent the company with external constituents
    • Intermediate Ability to influence internal and external constituents
    • Intermediate Demonstrated organizational skills
    • Advanced Ability to lead/manage others
    • Advanced Demonstrated interpersonal/verbal communication skills
    • Advanced Demonstrated negotiation skills
    • Advanced Knowledge of healthcare delivery
    • Advanced Knowledge of community, state and federal laws and resources
    • Intermediate Demonstrated project management skills
    • Advanced Other Strong knowledge with contracting language
    • Advanced Other Strong ability to handle service issues for providers
    • Intermediate Other Solid understanding of the contracting, credentialing and configuration process
    • Intermediate Other Able to anticipate and to appropriately overcome obstacles internally and externally
    Licenses and Certifications:
    A license in one of the following is required:
      Technical Skills:
      • Required Intermediate Microsoft Word Proficient in Microsoft Office such as Word, Excel, PowerPoint, Visio and Outlook
      • Required Intermediate Microsoft Excel
      • Required Intermediate Microsoft PowerPoint
      • Required Intermediate Microsoft Visio
      • Required Intermediate Microsoft Outlook

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        Last Updated On: 12/9/2015