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Sr Director Network Management
at WellCare Health Plans
Kapolei, HI

Sr Director Network Management
at WellCare Health Plans
Kapolei, HI

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Description

Department: Network Management

Reports to: Market VP

Location: 949 Kamokila Boulevard, Kapolei, HI 90707


Directs a team in managing physician contracting, network development, provider relations and provider operations. Develops, executes and maintains a provider network strategy. Continuously evaluates network to ensure cost effective, optimal functionality. Works in concert with medical management and sales to develop strategies to meet market growth and medical cost targets.

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.

    Candidate Education:
    • Required A Bachelor's Degree in Business, Healthcare or related field
    • Required or equivalent work experience
    • Preferred A Master's Degree in a related field
    Candidate Experience:
    • Required 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 experience
    Candidate Skills:
    • Advanced Demonstrated organizational skills
    • Advanced Demonstrated leadership skills
    • Advanced Other Knowledge of regulatory requirements concerning Medicare and Medicaid
    • Advanced Other Knowledge of provider contracts and health care reimbursement
    • Intermediate Other Understanding of regulatory compliance management and reporting requirements
    • Intermediate Other Ability to manage complex transaction and service models
    • Intermediate Other Demonstrated proficiency in establishing and driving medical cost management programs
    • Intermediate Other Ability to negotiate effectively with internal/external stakeholders, large hospital and physician healthcare systems

      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 www.wellcare.com. 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.

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