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National Ancillary Network Development Specialist, Sr Job Details

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Company:  WellCare Health Plans, Inc.
Job Code:  1102867
Categories:  For-Profit Senior Services
Job Role:  LPN / LVN / Nurse
Region/Province:  Florida (FL)
City:  FL-Tampa
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 vendor networks by developing and maintaining speciality networks and/or national ancillary providers on a national basis.  Achieves company targets through aggressive negotiatins with vendors, specialty and ancillary providers in assigned states/counties. 

  


Essential Functions:



  • Manages vendors (Specialty Networks) and national ancillary providers on an enterprise wide basis.

  • Negotiates contracts for multiple lines of business including rates, contract language negotiations and terms as necessary.

  • Negotiates capitation arrangements for "at risk" medical specialty contracts for National /Statewide level providers and vendors with delegated functions.

  • Manages RFP/RFI process for National level Vendors.  Develops corporate objectives, performs market research, develops evaluation criteria, completes assessment, conducts finalist interviews and examines findings with key stakeholders in addition to negotiating the final agreement and performance guarantees with selected vendor.

  • Works closely with the Medicare & Medicaid product teams and markets to facilitate member benefit design options and vendor rate quotes for enhanced member benefits.

  • Develops and negotiates standards for Performance Service Level Agreements with applicable penalties for vendors.

  • Evaluates medical cost trends and develops recommendations for new contracting initiatives/standards and evaluates overall success of ancillary contract performance.  Implements contracting action plans to achieve results.

  • Works collaboratively with each corporate region regarding market specific goals and objectives. 

  • Ensures effective contracting for company cost targets through aggressive vendor, specialty and national level ancillary provider negotiations.

  • Develops highly effective working relationships with vendors and providers as well as with internal matrix partners.

  • Manages these responsibilities for existing and new market expansions in the Medicare and Medicaid lines of business.

  • Maintains extensive knowledge in key functional areas such as provider operations, product design/benefit structures, claims, credentialing, member services, medical authorizations and continuity of care impact, actuarial review process, Medicare/Medicaid/SCHIP guidelines and a thorough understanding of government programs in the managed care industry.

  • Performs other duties as assigned.

Education:  A Bachelor's Degree in a related field or equivalent directly related experience

 

Experience:  10 years experience in network nevelopment.  5 years experience in managed care in a Medicare or Medicaid Health Plan.  Minimum of 3 years risk Contracting experience required.

 

Special Skills (e.g. 2nd language): 

Excellent influencing and complex negotiation skills.  Ability to analyze and explain complicated financial terms and utilization data to vendor physicians and staff.  Excellent written skills.  Excellent public speaking skills.  Knowledge of risk, capitated and FFS contracting.  Knowledge of negotiationg HMO conttacts.

 

Technical Skills/Requirements:  Proficient in Microsoft Office such as Word, Access, Excel, PowerPoint and Outlook.

Post Date:  02/02/2012

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