Provider Network Mgt Dir-(Medicare/Medicaid Contracting)-74535
Location: North Haven Connecticut
Description: WellPoint is hiring Provider Network Mgt Dir-(Medicare/Medicaid Contracting)-74535 right now, this career will be placed in Connecticut. Detailed specification about this career opportunity please give attention to these descriptions. WellPoint is one of the nation's leading health benefits insurers and a Fortune Top 50 company. At WellPoint, we are ! dedicated to improving the lives of the people we serve and the health of our communities. WellPoint strives to simplify the connection between health, care, and value for our customers.
Bring your expertise to our innovative, achievement-driven culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine.
Provider Network Mgmt Director
Person may be located at any WLP location or work from a home office. Responsible for developing the provider network through contract negotiations and relationship development with large health systems and multiple provider types including hospitals, physicians, ancillary providers, home & community based services (HCBS) and long term care (LTC) providers. Primary focus of this role is contracting and negotiating contract terms with a large component of time dedicated to network strategy on integrating nursing facility and community full dual members (members ! with Medicare and Medicaid coverage) into Medicaid managed car! e. This level spends a minimum of 50% of the time either in a leadership role or that of subject matter expert and deals with only the most complex providers. Essential duties may include, but are not limited to: Serves in a leadership capacity, leading associate resources, special projects/initiatives or network planning. Serves as subject matter expert on Medicaid contracting and network development, LTSS contracting and network development and Duals contracting and network development.
Typically serves as lead contractor for large scale, multi-faceted or highly specialized negotiations. Serves as business unit representative on enterprise initiatives around network management and leads projects with significant impact. May assist management in network development planning. May provide work direction and establish priorities for field staff and may be involved in associate development and mentoring. Works with the most complex providers. Complex providers may inc! lude, but are not limited to HCBS/LTC providers, institutional providers, large medical groups and ancillary providers, and providers in areas with significant competition. Contracts involve non-standard arrangements that require a high level of negotiation skills. Fee schedules are typically customized. Works independently and requires high level of judgment and discretion. May work on projects impacting the business unit requiring collaboration with other key areas or serve on enterprise projects around network management as needed. Essential duties may include, but are not limited to: Serves as a communication link between professional providers and the company. Conducts most complex negotiations. Prepares financial projections and conducts analysis as required. Performs other duties as assigned.
WellPoint is one of the nation's leading health benefits insurers and a Fortune Top 50 company. At WellPoint, we are dedicated to improving the lives of the people we serve ! and the health of our communities. WellPoint strives to simplify the co! nnection between health, care, and value for our customers.
Bring your expertise to our innovative, achievement-driven culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine.
Provider Network Mgmt Director
Person may be located at any WLP location or work from a home office. Responsible for developing the provider network through contract negotiations and relationship development with large health systems and multiple provider types including hospitals, physicians, ancillary providers, home & community based services (HCBS) and long term care (LTC) providers. Primary focus of this role is contracting and negotiating contract terms with a large component of time dedicated to network strategy on integrating nursing facility and community full dual members (members with Medicare and Medicaid coverage) into Medicaid managed care. This level spends a minimum of 50% of the time either in a lea! dership role or that of subject matter expert and deals with only the most complex providers. Essential duties may include, but are not limited to: Serves in a leadership capacity, leading associate resources, special projects/initiatives or network planning. Serves as subject matter expert on Medicaid contracting and network development, LTSS contracting and network development and Duals contracting and network development.
Typically serves as lead contractor for large scale, multi-faceted or highly specialized negotiations. Serves as business unit representative on enterprise initiatives around network management and leads projects with significant impact. May assist management in network development planning. May provide work direction and establish priorities for field staff and may be involved in associate development and mentoring. Works with the most complex providers. Complex providers may include, but are not limited to HCBS/LTC providers, institutional pr! oviders, large medical groups and ancillary providers, and providers in! areas with significant competition. Contracts involve non-standard arrangements that require a high level of negotiation skills. Fee schedules are typically customized. Works independently and requires high level of judgment and discretion. May work on projects impacting the business unit requiring collaboration with other key areas or serve on enterprise projects around network management as needed. Essential duties may include, but are not limited to: Serves as a communication link between professional providers and the company. Conducts most complex negotiations. Prepares financial projections and conducts analysis as required. Performs other duties as assigned.
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If you were eligible to this career, please email us your resume, with salary requirements and a resume to WellPoint.
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This career starts available on: Sat, 14 Sep 2013 00:50:47 GMT
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