Director Provider Relations at WellCare Health Plans

Posted in Management 22 days ago.

This job brought to you by Professional Diversity Network, Inc

Type: Full Time
Location: Columbus, Ohio

Job Description:

Department: Operations - Network
Reports to: Sr. Director
Location: Ohio (office address to be determined)
This position is contingent upon the bid award in the state of North Carolina to WellCare Health Plans, Inc.
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.
Essential 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.
Maintains compliance for State and CMS audits.
Special projects as assigned or directed. Additional Responsibilities:
Candidate Education:
Required A Bachelor's Degree in a related field or equivalent work experience directly related to the level and duties of the job Candidate Experience:
Required 7 years of experience in provider relations or similar background
Required 4 years of experience in management Candidate Skills:
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 Other Facilitative skills
Intermediate Other Provides proactive approach and support to emerging business activities established to remain competitive in the marketplace
Intermediate Other Ability to convert related activities into a comprehensive work plan
Advanced Other Financial skills
Advanced Other Knowledge of CMS and state regulations Licenses and Certifications:
A license in one of the following is required:
Technical Skills:
Required Intermediate Microsoft Word
Required Intermediate Microsoft Excel Languages:
About us
Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.