Senior Director, Provider Network
Posted on: 10 Jan 2021
Tampa, FL
Job Description
Position Purpose:
Design and implement successful development activities for the recruitment, contracting and retention of providers. May oversee other functional areas at the health plan such as operations or claims in conjunction with Corporate partnerships and guidelines.
* Ensure compliance with company policies and standards, state and federal laws, regulations and contracting standards
* Develop and implement strategic plans to align business goals and technologies with future needs
* Facilitate operational oversight for one or more departments.
* Effectively plan and manage budget, revenue targets and P&L, and all resources for short and long-term needs
* Prepare and analyze reports on departmental and organizational activities and recommend improvements
* Ensure timely set up, processing, auditing and distribution of network account data
* Develop, monitor and oversee the training programs and integrate programs into the organizational training plans
* Ensure positive account relationships exist with internal and external customers while maintaining adherence to Company policies and procedures.
* Create effective organizational structure and develop staff skills and competencies
Education/Experience:
Bachelors degree in a Business Administration, Healthcare Administration or related field or equivalent experience. 8+ years of provider relations or contracting experience, preferably in a managed care or insurance environment. Previous management experience including responsibilities for budgeting, hiring, training, assigning work and managing performance of staff. Experience with risk based contracts highly preferred.
Licenses/Certifications: Current state drivers license.
PLEASE NOTE THIS ROLE CAN BE FILLED IN ANY LOCATION THAT HAS A CENTENE OFFICE- PREFERABLY AS CLOSE TO FLORIDA AS POSSIBLE
Centene is proud to offer competitive benefits for this position. They are available for review at: https://jobs.centene.com/us/en/benefits. The salary range is $113,000-$175,000.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
WellCare
Tampa, FL
WellCare Health Plans, Inc. provides government-sponsored managed care services. The company operates in three segments: Medicaid Health Plans, Medicare Health Plans, and Medicare Prescription Drug Plans (PDPs). The Medicaid Health Plans segment offers plans for beneficiaries of temporary assistance for needy families, supplemental security income, and aged blind and disabled residents; and other state-based programs, such as children's health insurance programs and long-term services and supports programs for qualifying families who are not eligible for Medicaid.
The Medicare Health Plans segment provides Medicare, a federal program that provides eligible persons aged 65 and over, as well as some disabled persons with a range of hospital, medical, and prescription drug benefits; Medicare Advantage, a Medicare’s managed care alternative to the original Medicare program, which offers individuals standard Medicare benefits directly through Centers for Medicare & Medicaid Services; and coordinated care plans that are administered through health maintenance organizations and require members to seek health care services and select a primary care physician from a network of health care providers.
The Medicare PDPs segment provides Medicare part D PDP plans to Medicare-eligible beneficiaries. Its PDP plans offer national in-network prescription drug coverage, including a preferred pharmacy network. As of December 31, 2018, the company served approximately 5.5 million members in the United States. WellCare Health Plans, Inc. was founded in 1985 and is headquartered in Tampa, Florida.
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IndustryHealthcare
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No. of Employees12, 000
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Website
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Jobs Posted917
