GreensboroRecruiter Since 2001
the smart solution for Greensboro jobs

Network Management Rep-Greensboro

Company: Wellcare Health Plans
Location: Greensboro
Posted on: July 14, 2019

Job Description:

Manages physician contracting, network development and provider relations 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. Department: Provider Relations Location: Greensboro, NC Reports To: VP Field Network Manager Essential Functions: Services, 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 Additional Responsibilities: For smaller or emerging markets, the Network Management Representative may perform a dual role with Provider Relation duties. Some associates may perform one or all of the below Provider Relations duties: Completes new provider orientation for all applicable product lines. Conducts site visits to service providers to provides education on policies and initiatives, resolve issues, educate staff/providers on policies, collect credentialing information and review HEDIS information. Addresses RxEffect, P4P, Medical Home, Cultural Competency, FWA, open/closed panels, ADA, PaySpan, ER overuse, et al. Achieves frequency goals to establish consistent and strong relationship with provider offices. Partners with local and national ancillary for appropriate vendor management and coordinates the transition of the delegated providers following a network termination. Provides oversight on claims issues. Follows up with providers accordingly. Monitors and supports providers using utilization reports, pharmacy profiles, ER contingencies, Frequent Flier Reports and other analytics available to improve and maintain regions. Understands and explains fee-for-service and risk contracts, and provides reporting on provider and/or Service Fund performance. Proactively strategies for membership growth and retention, through advanced communication to providers, as well as follow-up to gauge the response to that growth. Partners with Network Development to identify network gaps and suggests additional providers for recruitment to ensure network adequacy. Ensures contract SLA's are met, such as meeting with PCP's and Specialists on a monthly, quarterly, or annual basis to address provider panels, after hour's availability and EMR meaningful use. Maintains provider data integrity including monitoring provider credentialing, location additions, demographic updates, and terminations. Partners with finance to identify Medical Expense Initiatives to take actions necessary to successfully complete those initiatives, and assess progress on achieving financial goals. Provides continual training to assigned providers on wellcare.com portal and other resources to assist with claims, authorizations, member benefits, etc. Candidate Education: Required A Bachelor's Degree in a related field Required or equivalent work experience directly related to Network Development or Provider Relations with demonstrated ability to perform the job duties Candidate Experience: 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 Required 1 year of experience in managed care Required Other Previous contracting experience Candidate Skills: Intermediate Demonstrated written communication skills Intermediate Demonstrated negotiation skills Intermediate Knowledge of healthcare delivery Intermediate Demonstrated customer service skills Intermediate Ability to represent the company with external constituents Intermediate Demonstrated interpersonal/verbal communication skills Intermediate Ability to multi-task Intermediate Ability to analyze and interpret financial data in order to coordinate the preparation of financial records Intermediate Ability to work independently Intermediate Ability to work within tight timeframes and meet strict deadlines Intermediate Demonstrated analytical skills Intermediate Demonstrated organizational skills Licenses and Certifications: A license in one of the following is required: Technical Skills: Required Intermediate Microsoft Word Required Intermediate Microsoft Excel Required Intermediate Microsoft Outlook Languages: 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.

Keywords: Wellcare Health Plans, Greensboro , Network Management Rep-Greensboro, Executive , Greensboro, North Carolina

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Executive Jobs


Director of Digital Content
Description: Director of Digital Content Job DescriptionHemmings is seeking a dynamic leader, team builder, and managerwho and thrives on growth and results. The Director of DigitalContent is responsible for the population (more...)
Company: Hemmings
Location: Charlotte
Posted on: 07/23/2019

Property Management Assistant
Description: The property management assistant will provide administrative support to the Industrial property management team. In addition, this position will coordinate tenant repairs, complaints, and assist with (more...)
Company: Childress Klein
Location: Charlotte
Posted on: 07/23/2019

14G Air Defense Battle Management System Operator
Description: 14G Air Defense Battle Management System Operator br br Job ID: 1080228 br br Job Views: 31 br br Location: CHARLOTTE, North Carolina, United States br br ZIP Code: 28208 br br Job (more...)
Company: Army National Guard
Location: Charlotte
Posted on: 07/23/2019


Director of Evaluations
Description: Atleast 5 years foreign credential evaluation experience is REQUIRED for this position. Any applicants without will NOT be considered. Our team is quickly growing so if you do not meet these requirements, (more...)
Company: International Education Evaluations, Inc.
Location: Charlotte
Posted on: 07/23/2019

FT Assistant Customer Service Manager - Food Lion
Description: Job Number 19- Post Date 07/16/2019 Job Title FT Assistant Customer Service Manager - Food Lion Positions Available 1 Operating Company Food Lion Full/Part Time Status Full-Time FLSA Status Non-Exempt (more...)
Company: Food Lion, LLC
Location: Charlotte
Posted on: 07/23/2019

Program Test Manager / Senior Business Analyst with Life and Annuity
Description: 12 Years of working experience in Life and Annuity Insurance Strong functional
Company: MPRSoft Inc
Location: Charlotte
Posted on: 07/23/2019

Chief Talent Officer
Description: Job Description Specific information related to the position is outlined below. To apply, click on the button above. You will be required to create an account or sign in with an existing account . Your (more...)
Company: BB&T Corporation
Location: Charlotte
Posted on: 07/23/2019

Reporting & Analytics Manager - Audit Services
Description: Job DescriptionAt Wells Fargo, we want to satisfy our customers financial needs and help them succeed financially. Were looking for talented people who will put our customers at the center of everything (more...)
Company: Wells Fargo
Location: Charlotte
Posted on: 07/23/2019

Finance Manager
Description: We are looking for a finance manager that is proficient in Reynolds and Reynolds and CDK DMS systems. Must be a notary
Company: Keffer Hyundai
Location: Charlotte
Posted on: 07/23/2019

Analytic Manager 5
Description: Job DescriptionAt Wells Fargo, we want to satisfy our customers financial needs and help them succeed financially. Were looking for talented people who will put our customers at the center of everything (more...)
Company: Wells Fargo
Location: Charlotte
Posted on: 07/23/2019

Log In or Create An Account

Get the latest North Carolina jobs by following @recnetNC on Twitter!

Greensboro RSS job feeds