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Network Performance Advisor

Company: WellCare
Location: Jackson
Posted on: October 11, 2019

Job Description:

WellCarehas an immediate opportunity for a Network Performance Advisor to join our Missippissiteam! In this role you will serve as akey point of contact and liaison between assigned strategic providers andvarious departments within WellCare, including Quality, Operations, Finance,Health Services and other shared services departments. You will also develop and execute thestrategy for your assigned providers, including building strong workingrelationship; building trust, maintaining high provider satisfaction andhelping providers improve their performance. Our ideal candidate is someone with experience in healthcare orinsurance and who has solid Network Management/Network Development, ProviderRelations, Risk and /or Value Base Contracting experience. At WellCare, we empower you to manage therelationship and provide the resources to be successful. This position offers a robust benefitspackage including over 3 weeks of paid time off, 8 holidays and 2 floatingholidays and much more! Reports to: Director, Provider Relations Department: Provider Relations Location: Jackson, MS 39211
***Must reside in AL, AR, MS or TN. Territory includes AL, AR, MS and TN***
Essential Functions:

  • Owns and manages the relationship and performance of key provider groups.
  • Influences provider behaviors to drive improvements in provider & member satisfaction, optimizing member outcomes and maximizing shared savings.
  • Drives improvement of provider performance by analyzing, interpreting and communicating financial, utilization and quality metrics.
  • Establishes and leads cross-functional communication and collaboration with internal departments to support provider performance and resolve barriers and challenges.
  • Responsible for understanding the differences between Risk and Value-Based contracting and driving improved provider performance.
  • Plans, prepares, and executes effective group meetings/discussions with proper objectives and outcome.
  • Responsible for understanding unique contract, quality, network requirements of Medicaid and Medicare.
  • Responsible for understanding HEDIS and STARS measures and partner the Quality team to drive improved provider performance.
  • Special projects as assigned or directed.
    Candidate Education:
    • Required A Bachelor's Degree in Health Care, Business, Finance or any other field
    • Required or equivalent work experience in Network Management/Network Development, Provider Relations, Risk and /or Value Base Contracting Candidate Experience:
      • Required 5 years of experience in Network Management/Network Development, Provider Relations, Risk and/or Value Base Contracting, managed care organization
      • Required 2 years of experience in Account Management or management experience
      • Required Other Candidate Skills:
        • Advanced Other Ability to establish and manage multi-disciplinary meeting approach with key provider groups
        • Advanced Other Ability to communicate and effectively influence provider's performance
        • Advanced Other Ability to operate as lead point of contact for key provider groups
        • Advanced Other Ability to build and maintain strong and long lasting partnerships with key provider groups
        • Intermediate Other Ability to manage and work under pressure
        • Advanced Other Creates and maintains meaningful & proactive communication with provider groups
        • Intermediate Other Manage Provider's experience and satisfaction with health plan
        • Advanced Other Ability to forecast, track, and monitor provider performance
        • Advanced Other Strong interpersonal skills that build rapport and trust with provider groups
        • Advanced Other Excellent cross-functional communication with internal departments (OAR, QPA, Case Management, Field Finance) Licenses and Certifications:
          A license in one of the following is required:
          Technical Skills:
          • Required Advanced Microsoft Excel
          • Required Advanced Microsoft Outlook
          • Required Advanced Microsoft Word Languages:
            About usHeadquartered 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, Jackson , Network Performance Advisor, Other , Jackson, Mississippi

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