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Provider Network Management Specialist

Company: WellCare
Location: Lafayette
Posted on: May 19, 2019

Job Description:

Manages physician contracting, network development and provider relations functions for developing, executing and maintaining a provider network strategy. Works in concert with medical management and sales developing actions to meet market growth and medical cost targets. Provides service and education to network physicians/providers. Reports to: Director, Network Management Department: Network DevelopmentLocation: Lafayette, LA Essential Functions:

  • Manages the network for IPA's, primary care and specialty physicians and ancillary providers.
  • Achieves company targets through aggressive IPA primary care, specialty and ancillary provider contracting and risk contract management.
  • Manages physician network by developing and maintaining relationships to drive business results within a specific geographic area.
  • Provides service and education to network physicians/providers.
  • Conducts site visits to service providers, resolves issues, educates staff/providers on policies, collects credentialing information, and reviews HEDIS information.
  • Supports regional Network Improvement Plan targets by providing utilization reports, pharmacy profiles, ER contingencies, Frequent Flier Reports and other analytics available to improve/maintain regions.
  • Manages incoming provider inquiries: identifies potential claims trends and follow-up with provider and internal departments to ensure that identified problems have been resolved.
  • Strategizes for membership growth and retention.
  • Special projects as assigned or directed Education: Bachelor's degree preferred or equivalent directly related Network Development or Provider Relations experience.

    Experience: 5 years experience in Provider Relations or Network Development. 3 years experience with managed care. IPA/Risk Contracting experience required.

    Special Skills (eg 2nd language): Excellent influencing and negotiating skills. Ability to analyze and explain complicated financial terms and utilization data to physicians and staff. Excellent written skills. Excellent public speaking skills.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. 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.

Keywords: WellCare, Lafayette , Provider Network Management Specialist, Executive , Lafayette, Louisiana

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