Responsible for the overall operations of the health plan, including strategic direction, administration of all existing programs and development of new programs to ensure goals and objectives are met or exceeded. Working closely with the Division President and WellCare's executive leadership team, leads and directs overall operations including: provider contracting and relations, sales and marketing, medical management, regulatory compliance, government relations and finance, as well as interfacing with corporate office operations. May serve as the representative of the health plan to government entities and other external agencies. Ensures compliance with all relevant state and federal regulatory agencies, contracts and regulations.
- Leads and directs the day to day operations of the health plan. This includes providing leadership and direction to the management team to ensure the organization's strategic plan is translated into tactical goals and objectives that guarantee performance objectives are met or exceeded.
- Sets the tone from the top that compliance with all regulations and contract adherence is critical to WellCare success.
- Directs and manages the organization's financial performance. Takes appropriate actions to increase revenue, leverage resources, manage and/or minimize expenses.
- Directs the development of annual budgets and presents the budgets for approval.
- Assists and leads where appropriate, with aspects of state and federal government relationships, including working with regulators, as necessary, to establish and continue effective working relationships. Ensures that all state and federal regulations are met.
- Oversees the development and maintenance of a viable provider network to ensure the health care needs of WellCare members are met. Develops or manages provider contracts and partnerships to achieve quality and cost management objectives. Works closely with providers to enhance relationships and maximize their ability to effectively manage the cost of medical delivery.
- Oversees the development, implementation and continuous evaluation of the utilization and quality management program for medical services delivered by contracted health care providers.
- Oversees the development and implementation of short and long term sales and marketing plans.
- Leads organizational development activities that develop and foster strong working relationships among the members of the management team. Builds and promotes the culture of the plan to be consistent with the values established by the corporate office.
- Establishes formal and informal mechanisms to promote and maintain credibility, competence, and a positive corporate image by exhibiting strong communication to the corporate office, providers, members and committees.
- Develops new models and processes to meet future business needs
- Provides problem analysis and problem resolution at both a strategic and functional level
- Recommends and leads improvement processes and initiatives
- Performs other related duties as assigned by management
This position is contingent upon the bid award in the state of New Mexico to WellCare Health Plans, Inc.
- Bachelor's degree in business administration, finance, healthcare administration or a related field required, with a master's degree strongly preferred
- 5-7 years of senior management experience with profit and loss accountability for a managed care organization.
- Comprehensive knowledge of delivery system operations, provider contracting, strategic planning and overall service delivery
- Powerful leadership skills with a vision and understanding of the future and subsequent changes required to meet business needs
- Ability to retain confidentiality regarding privileged company information
- Provides proactive approach and support to emerging business activities established to remain competitive in the marketplace
- Proven ability to affect change and meet business goals, monitor progress and take corrective actions when necessary
- Outstanding verbal and written communication skills
- An extremely organized, disciplined, hands on and process oriented leader who is not afraid of digging into details when necessary
- A "failure is not an option" mentality and demonstrated proactive management style.
- Strong business acumen, intelligence, and capacity. Thinks strategically and implements tactically.
- Problem solves and approaches work from a "return on investment" perspective.
- Ability to work in a high energy, fast paced and data driven environment with changing priorities.
- Ability to think creatively and out of the box.
- Ability to remain calm under pressure.
- Ability to organize tasks and work environment.
- Knowledge of Microsoft Office Word, Excel, PowerPoint and Outlook.
- Knowledge of and/or ability to utilize a budgetary decision application.