Advertisement

Manager, New Market Development Job Details

back to search results

Vacancy has expired

Company:  WellCare Health Plans, Inc.
Job Code:  1102877
Categories:  For-Profit Senior Services
Job Role:  Sales / Marketing / Community Relations
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.Promotes and markets the company in new markets where name recognition may be limited.  Oversees the network development and provider service functions within new market and expansion territories. Works with finance, legal, medical management, sales, provider operations and provider service center personnel in developing actions to meet market growth and medical cost targets and excellent provider customer service.

  • Develops comprehensive network strategies to support market growth and medical cost targets.

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

  • Works closely with the state and in-house Network Development/Provider Relations staff regarding claims issues and contracting questions.

  • Assists in the analysis of market information to derive conclusions to support new business contract negotiations.

  • Identifies network gaps and completes contracts.  Reviews out-of-network negotiations, identifies new providers for contracting and completes contracting.

  • Analyzes claim trend data and/or market information to derive conclusions to support positive business and potentially risk arrangements.

  • Conducts face to face educational meetings to ensure providers and staff understands Companies' policies and procedures (RAPS, service funds, cost reallocation, claim contestation).

  • Interacts and communicates with finance personnel and senior management regarding network/provider performance.

  • Assists the finance and IT departments with identifying improvements or opportunities for WC and providers to more efficiently manage risk membership.

  • Performs contract administration including maintaining local files and documentation, ensuring LOA's are converted to contracts, and meeting GEOACCESS requirements for LOB's.

  • Performs special projects as assigned.     


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

 

Experience:  5 years network development and/or contracting experience.  Managed Care experience required.  Experience in network development for Medicare or Medicaid is strongly preferred.

 

Licenses/Certifications:                             

 

Special Skills (e.g. 2nd language): 

Ability to operate in an environment with high expectations and short time lines

Strong financial and analytical background

Strong contracting language knowledge and experience

Experienced in handling service issues for providers

Solid understanding of the contracting, credentialing and configuration process within claims processing

Knowledge of risk, capitated and FFS contracting

Able to anticipate and to appropriately overcome obstacles internally and externally

Excellent influencing and negotiating skills

Ability to explain complicated financial terms and utilization data to physicians and staff

Excellent written skills and the ability to speak publicly

Must be organized and have excellent time management capabilities

Ability to analyze data to identify trends and variance from goals

 

 

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


 
Post Date:  01/31/2012

Featured Jobs