Network Management - Senior Director

WellCare Health Plans   •  

Houston, TX

Industry: Healthcare


11 - 15 years

Posted 123 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 riskcontract 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 financialrisk.
  • 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.

This position is contingent upon the bid award in the state of Texas to WellCare Health Plans, Inc.*LI-SM1


  • A Bachelor's Degree in Business, Healthcare, related field required or equivalent work experience
  • A Master's Degree in a related field preferred.


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

Special Skills:

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

Technical Skills:

  • Intermediate proficiency in Microsoft Outlook, Word, Excel and PowerPoint.
  • Knowledge of and/or ability to utilize a budgetary software application