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Network Performance Analyst Job Details

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Company:  WellCare Health Plans, Inc.
Job Code:  1000522-93199
Categories:  For-Profit Senior Services
Job Role:  Insurance
Region/Province:  New York (NY)
City:  NY-Manhattan
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.
Assist in the development and presentation of timely, accurate, actionable data and analysis supporting the Network Performance Improvement.  Provides proactive analysis and recommendations to senior management on both tactical and strategic initiatives.  Work with targeted NIP providers to evaluate and improve overall financial performance.

 

Essential Functions:


  • Proactive involvement with identification, evaluation, monitoring and execution of medical cost savings initiatives.

  • Reviews analysis of medical cost trends/drivers associated with the monthly MBR reporting in conjunction with the release of the monthly reports.

  • Participates in and facilitates identification, valuing and monitoring of company sponsored medical cost initiatives.

  • Conducts face-to-face service/educational meetings to ensure providers and staff understand NIP deliverables.

  • Provides reliable and accurate MBR reporting to Providers and Market Director.

  • Works with the technical team to identify/implement improvements in quality control/timeliness of reporting.

  • Works with business owners to help markets/providers understand their financial information

  • Provides analysis of material changes in MBR levels from month to month in conjunction with the release of the monthly reports

  • Contributes to cross-functional teams to address key issues facing the organization.

  • Builds expertise in specific areas of medical cost management.  Leverage this expertise across other markets and regions.

  • Coordinates and participate in research-related activities including industry best-practices, research and development of models, tools, and data analysis projects and experience studies.

  • Performs other duties as assigned.

Education:

A Bachelor's Degree in Finance, Business Administration or related field.

 

Experience: 

2-3 years provider relations, provider contracting or network development experience required.  Experience in a financial background desired.  Experience analyzing health claims data preferred.  Experience in Medicare/Medicaid government program preferred.

 

Licenses/Certifications:  N/A                         

 

Special Skills (e.g. 2nd language): 

Superior oral and written communication skills

Ability to effectively communicate complex messages to all levels inside/outside the organization

Special attention on the ability to communicate effectively to senior management

Strong analytical skills

Ability to work in a fast paced environment with changing priorities

Ability to multi-task and work under pressure

Ability to define problems, collect data, establish facts, and draw valid conclusions.

Ability to remain calm under pressure.

 

Technical Skills/Requirements:   Proficient in Microsoft Office such as Excel, Word, Access, PowerPoint and Outlook.
Post Date:  07/19/2010
 

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