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Provider Relations Rep #2 Toledo, OH Job Details

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Company:  WellCare Health Plans, Inc.
Job Code:  1102017
Categories:  For-Profit Senior Services
Job Role:  Insurance
Region/Province:  Ohio (OH)
City:  OH-Independence
Job Description:  !*!About WellCare: WellCare Health Plans, Inc. (NYSE: WCG) provides managed care services exclusively for government-sponsored health care programs, focusing on Medicare and Medicaid. Our experience and our exclusive commitment to these programs enable us to serve our members and providers as well as manage our operations effectively and efficiently.

A 2008 Fortune 500 company headquartered in Tampa, Florida, WellCare offers a variety of health plans for families, children and the aged, blind and disabled, as well as prescription drug plans. The company employs approximately 3,500 associates and serves nearly 2.4 million members nationwide as of March 31, 2011. For more information about WellCare, please visit the Company's website at www.wellcare.com.
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.  Achieves company targets through implementation of Network Improvement plans.

 

Essential Functions: 


  • Completes new provider orientation for all applicable product lines.
  • Conducts site visits to service providers, resolve issues, educate staff/providers on policies, collect credentialing information, and review HEDIS information.
  • Achieves call reach and frequency goals to establish consistent and strong relationship with provider offices.
  • Provides oversight on inquiries and claims issues and follows up with providers to ensure problems have been resolved.
  • 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.
  • Identifies network gaps and completes contracts or works with Network Development.
  • Understands and explains risk contracts.
  • Strategizes for membership growth and retention.
  • Provides oversight of delegated functions as applicable.
  • Special projects as assigned or directed
Education:  Bachelor's degree preferred or equivalent directly related experience

 

Experience:  Minimum one (1) year experience in Medicaid/Medicare is preferred.  Pharmacy, healthcare, provider or HMO/PPO background preferred.

 

Special Skills (e.g. 2nd language):  Excellent problem solving skills.  Excellent oral and written communication skills.  Must be organized and have excellent time management capabilities.  Ability to analyze data to identify trends, and variance from goals.

 
Post Date:  01/28/2012

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