Director Network Management

WellCare Health Plans, Inc   •  

Omaha, NE

Industry: Healthcare

  •  

8 - 10 years

Posted 39 days ago

This job is no longer available.

Directs a team in managing physician contracting, network development, provider relations and provider operations. Develops, executes and maintains a provider network strategy. Works in concert with medical management and sales to develop strategies to meet market growth and medical cost targets. Provides service and education to network physicians/providers.


Essential Functions:

  • Leads a team of department managers in developing and executing strategic departmental initiatives.
  • Achieves company targets through aggressive IPA primary care, specialty and ancillary provider contracting as well as risk contract management.
  • Manages required Hospital Contracting as appropriate.
  • Monitors primary care and specialty risk arrangements for Medicaid, and Medicare product lines.
  • Performs data analysis and develops specific actions to manage medical cost trend.
  • Develops best practice to assist risk partners in managing financial risk.
  • Identifies areas to improve provider service levels.
  • Educates/enhances relationships within the provider community.
  • Manages Network integrity and compliance.
  • Manages claims projects as necessary/required.
  • Manages provider loads as necessary/required.
  • Special projects as assigned or directed.

Additional Responsibilities:


Candidate Education:

  • Required A Bachelor's Degree in Business, Healthcare or related field
  • Required or equivalent work experience with directly related hospital and/or network contracting experience beyond the 5-7 years required
  • Preferred A Master's Degree in a related field

Candidate Experience:

  • Required 7 years of experience in healthcare sector (preferably at HMO or PPO)
  • Required 5 years of experience in HMO provider/hospital/ancillary contracting and network development
  • Required 4 years of management experience

Candidate Skills:

  • Intermediate Demonstrated organizational skills
  • Intermediate Demonstrated leadership skills Disciplined, hands-on and process-oriented leader
  • Advanced Other Knowledge of regulatory requirements concerning Medicare and Medicaid
  • Advanced Other Knowledge of provider contracts and health care reimbursement
  • Advanced Other Understanding of regulatory compliance management and reportingrequirements
  • Intermediate Other Ability to manage complex transaction and service models
  • Intermediate Other Demonstrated proficiency in establishing and driving medical cost management programs
  • Advanced Other Ability to negotiate effectively with internal/external stakeholders, large hospital and physician healthcare systems

Licenses and Certifications:

A license in one of the following is required:

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