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Network Management Rep, Sr - Orlando Job Details

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Company:  WellCare Health Plans, Inc.
Job Code:  1000354-87710
Categories:  For-Profit Senior Services
Job Role:  Insurance
Region/Province:  Florida (FL)
City:  FL-Orlando
Job Description:  !*!About WellCare: We provide managed care services targeted exclusively to government-sponsored health care programs, focused on Medicaid and Medicare, including prescription drug plans and health plans for families, and the aged, blind and disabled. As of March 31, 2009, we served nearly 2.5 million members. Our experience and our exclusive commitment to these programs enable us to serve our members and providers, and to manage our operations efficiently.

Our History: Founded in 1985 with three associates, WellCare grew to more than 800 associates and 467,000 members in Florida, New York and Connecticut by 2002. In 2004, the Company acquired Harmony to enter the Midwest and became publicly traded. By 2006, WellCare served 2.2 million members as it became a national PDP provider and the largest Medicaid plan in Georgia. Today WellCare has grown to be the eighth largest publicly traded health care plan in the country with 3,800 associates and nearly 2.5 million members nationwide.
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.

 

Essential Functions:



  • Services, contracts and negotiates with primary care and specialty physicians and ancillary providers for all product lines.

  • Identifies network gaps and complete contracts.

  • Manages physician network by developing and maintaining relationships to drive business results within a specific geographic area.

  • 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, resolve issues, educate staff/providers on policies, collect credentialing information, and review 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.


 

Education:  Bachelor's degree preferred or equivalent directly related Network Development or Provider Relations experience

 

Experience:  3 years experience in Provider Relations or Network Development.  3 years experience with managed care.  Previous contracting experience required. 

 

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

 

 
Post Date:  08/04/2010
 

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