Serves as the enterprise subject matter expert on all matters pertaining to network strategy, value-based contracting, and provider engagement / solutions. Collaborates with field leadership and key shared services stakeholders to advance Company's value-based contracting agenda and goals. Provides strategic leadership, as well day-to-day responsibility for decisions, for major enterprise programs and products related to physician engagement and network solutions.
Reports to: VP, Network Performance
Dept.: CNS Network Strategy
Location: Tampa, FL
Additional Responsibilities:Candidate Education:
- Partners with field network teams, national contracting team and key shared services stakeholders to advance the execution of the Company's network transformation strategy specifically related to improving practice performance and provider engagement with WellCare cost and quality goals.
- Designs new value based contract model templates to support Market business priorities. Collaborates with field network teams, Legal, Finance, Operations, Compliance and other key stakeholders to ensure templates are compliant, clear to providers, and able to be administered by WellCare systems.
- Coordinates monthly communication forums with each State's Network Leadership Team to ensure bi-directional flow of information on key issues, identify market support needs, and facilitate sharing of best practices.
- Chairs recurring weekly National Network Advisory Group ("NNAG") meetings. Identifies agenda topics that are relevant and focuses on key issues requiring stakeholder discussion. Works with presenters and other stakeholders in advance of meetings to ensure content of meeting materials is complete and supports driving to consensus and decision-making on important topics. Drives consensus building and decision making around key initiatives and goals which require market adoption.
- In collaboration with field network teams, design and execute major projects related to provider engagement and network solutions, including but not limited to the transformation and continued evolution of Company's Provider Engagement Model, Provider Contract Automation project, and Practice EMR Connectivity.
- Oversees designated enterprise-wide capital projects including market wide-deployment of applications and reporting tools,
- Oversees key performance indictors and metrics related to value-based contracting and strategic network solutions (e.g. EMR connectivity; E2E Contract TAT) to support comprehensive department reporting package overseen by Network Performance. Acts as "Business Owner" for these specific metrics to ensure accuracy and proper context for Senior Leadership.
- Partners with Business Development Team and Network Expansion Team to support early-stage activities in new "greenfield" markets related to identifying (and in some cases, contracting) with key provider partners to support WellCare's RFP responses.
- Supports Corporate Development & Strategy opportunities via participation in upfront evaluation (due diligence) activities and post-closing integration activities as directed by VP, Corporate Network Performance.
- Leads early stages of negotiations for new provider partnership opportunities and coordinates hand offs to local or national contracting teams (e.g. new value-based models; national contract frameworks requiring cross-market coordination). Owns and maintains all Company policies and procedures related to value-based contract and other strategic network topics.
- Performs other duties as assigned.
- Required A Bachelor's Degree in Business, Finance or related field
- Preferred A Master's Degree in Business, Public Health or Legal
- Required 10 years of experience in Managed Care or Provider Organization
- Required 7 years of experience in network management, hospital contracting, ancillary contracting, provider contracting and/or practice management
- Required 5 years of management experience With proven track record of health care industry experience
- Advanced Ability to analyze and interpret financial data in order to coordinate the preparation of financial records
- Advanced Ability to represent the company with external constituents
- Advanced Ability to effectively present information and respond to questions from peers and management
- Advanced Ability to communicate and make recommendations to upper management
- Advanced Demonstrated written communication skills
- Advanced Ability to work in a fast paced environment with changing priorities
- Advanced Demonstrated time management and priority setting skills
- Advanced Demonstrated project management skills
- Advanced Demonstrated negotiation skills
- Advanced Demonstrated interpersonal/verbal communication skills
- Advanced Knowledge of healthcare delivery
- Advanced Ability to implement process improvements
- Advanced Demonstrated leadership skills
- Advanced Demonstrated problem solving skills
- Advanced Ability to influence internal and external constituents
- Required Intermediate Microsoft Outlook
- Preferred Advanced Microsoft Excel
- Required Intermediate Microsoft Word
- Required Advanced Microsoft PowerPoint