Manager, Contracting & Network Development
Posted on: 7 Feb 2021
Tampa, FL
Job Description
Position Purpose:
Provide support for the management of physician, hospital and ancillary provider recruitment in accordance with corporate, health plan and state guidelines for assigned regions.
* Implement development activities for the recruitment and contracting of providers in provider networks in new and prospective markets
* Promote, maintain and manage team goals and objectives through effective hiring, performance management, coaching and career development
* Collaborate interdepartmentally for new and existing market expansions to ensure network operations deliverables are identified and completed as defined by the state Request for Proposals (RFPs) and/or state contract
* Manage and conduct effective contract negotiations and develop strategies, tactics and methods for specific network development initiative
* Manage provider data management functions through a new RFP and/or state contract implementation with strategies that promote provider network
* Monitor operational and financial performance of contracts to guide future recruitment activities and future contract negotiations
* Develop a comprehensive provider network to meet or exceed contractual requirements
* Contribute to the development and use of provider marketing and training materials assuring compliance with all state, federal, and product guidelines in new and existing markets
* Contribute to the development of contract reimbursement methodologies, reimbursement allotment, and covered benefit grid to ensure contracts and fee schedules are performing optimally
* Ability to travel
Education/Experience:
Bachelors degree in Health Administration, Business Administration, related field, or equivalent experience. 4+ years of provider recruitment, contracting, contract analysis, or provider relations experience. Must be knowledgeable of network development processes, contract language, principles of negotiation, credentialing and call center operations.
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.
title:Manager, Contracting & Network Development
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
