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Network Management Representative- Rock Island/ Quad Cities/ Davenport/ Jo Daviess counties
at Meridian
Davenport, IA

Network Management Representative- Rock Island/ Quad Cities/ Davenport/ Jo Daviess counties
at Meridian
Davenport, IA

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Description

Overview

Who we are: 

Meridian, a WellCare Company, is part of a national network of passionate leaders, achievers, and innovators dedicated to making a difference in the lives of our members, our providers and in the healthcare industry. 

 

We provide government-based health plans (Medicare, Medicaid, and the Health Insurance Marketplace) in Michigan, Illinois, Indiana, and Ohio.  As a part of the WellCare Family of companies, we deliver healthcare excellence to millions of members nationwide. 

 

Our associates work hard, play hard, and give back. Meridian associates enjoy an exceptional experience and culture including special events, company sports teams, potlucks, Bagel Fridays, and volunteer opportunities. 

 

*Ideal candidate must live in or near one of the counties listed on the job description*

 

A Day in the Life of a Network Management Representative:

Manages physician contracting and network development for an assigned region. Responsible for developing, executing and maintaining a provider network strategy. Continuously evaluates network to ensure cost effective, optimal functionality. Works in concert with medical management and sales developing actions to meet market growth and medical cost targets.

Responsibilities

  • Contracts and negotiates with primary care, specialty physicians and ancillary providers for all product lines in assigned markets.
  • Manages physician network by developing and maintaining relationships to drive business results within a specific geographic area.
  • Identifies strategies to achieve Medical Expense Initiatives (MEI).
  • Performs ongoing research to identify new providers or areas of expansion in assigned market.
  • Responds to provider’s contract requests and inquiries.
  • Analyzes network gaps and identifies providers to contract.
  • Reviews and amends provider’s contracts when necessary.
  • Evaluates contracted network to ensure functionality.
  • Assesses performance and contract rates of providers to ensure our network is cost efficient.
  • Researches and develops relationships with non-contracted providers.
  • Collects credentialing and required documents for newly contracted providers.
  • Strategies for membership growth and retention.
  • Performs special projects as assigned

Qualifications

What you can bring to Meridian:

  • Bachelor’s degree in a related field or equivalent work experience directly related to Network Development or Provider Relations with demonstrated ability to perform the job duties required.
  • 2+ years of experience in Provider Relations, Network Management, Hospital Contracting or related Provider Services position with demonstrated ability to perform the level of duties of the position is required.
  • 1+ year of experience in managed care is required.
  • Previous contracting experience is preferred
  • Intermediate proficiency with Microsoft Word, Microsoft Excel and Microsoft Outlook is required.

 

What Meridian can offer you: 

 

  • Ourhealthcare benefits include a variety of plans that are effective on the first day of employment for our new full-time team members.  
  • Opportunity to work with the industry’s leading technologies and participate in unique projects, demonstrations, conferences, and exclusive learning opportunities. 
  • Meridian offers 401k matching that is above the national average.  
  • Full-time Meridian employees are eligible fortuition reimbursement towards Bachelor’s or Master’s degrees. 
  • Meridian was namedDetroit's #1 Fastest Growing Company by Crain's Magazine, so it is a great time to get involved with Meridian. 

 

Equal Opportunity Employer 

#MSTR

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