Responsible for the overall operations of the health plan, including strategic direction, administration for all existing programs and the development of new programs to ensure goals and objectives are met or exceeded. Working closely with WellCare's executive leadership team, leads and directs the overall improvement of operations including: provider contracting and relations, sales and marketing, medical management, regulatory compliance and finance, as well as interfacing with corporate office operations. Serves as the representative of the health plan to government entities and other external agencies and ensures compliance with all relevant regulatory agencies. Essential Functions:
- 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.
- Directs and manages the organization's financial performance. Takes appropriate actions to increase revenue, leverage resources, manages and/or minimizes expenses and ensure compliance with all business and administrative regulations.
- 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 dealing 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. Develops and 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 and implements key components of business strategy.
- Develops new models and processes to meet future business needs.
- Sets company priorities.
- Establishes reporting systems and controls to ensure compliance with company requirements.
- Recommends, develops, and aligns policies and procedures with company objectives.
- Provides problem analysis and problem resolution at both a strategic and functional level.
- Recommends and leads improvement processes and initiatives.
This position is contingent upon the bid award in the state of New Mexico to WellCare Health Plans, Inc.Education/Experience:
- Bachelor's Degree in business administration, finance or a related field, with a Master's Degree strongly preferred
- Minimum of 5-7 years of senior management experience with P&L accountability for a managed care organization. Successful track record in: Provider Relations, ownership of top and bottom line P&L responsibility with a successful HMO (government program experience preferred), growing membership and revenue, and improving the MLR.
- Extensive experience in provider contracting.
- Broad knowledge of the managed care industry and proven experience leading governmental programs.
- 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.
- Sales background preferred with ability to motivate a sales force.
- 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.
- Knowledge of Microsoft Outlook, Word, and Excel.
- Knowledge of and/or ability to utilize budgetary software.
- An extremely organized, disciplined, hand's 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.
- Able to work in a matrixed reporting environment.
- Ability to work in a high-energy, fast-paced and data-driven environment.
- Highly flexible regarding schedules, ability to shift priorities.
- Ability to think creatively and out of the box.
- Ability to remain calm under pressure.
Job Number: 1703952