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Network Development Representative, Sr

BrentwoodWellCare


Manages physician contracting and network development for an assigned region. Responsible for developing, executing and maintaining a provider network contracting strategy. Continuously, evaluates network to ensure cost effective, optimal functionality.   Works in concert with medical management and sales developing actions to meet market growth and medical cost targets. Provides service and education to network physicians/providers.
 

REPORTS TO: DIRECTOR, PRODUCT OPERATIONS
DEPARTMENT: TN-OPERATIONS STATE
POSITION LOCATION: BRENTWOOD OR MEMPHIS, TN
 
Essential Functions:
•Contracts and negotiates with primary care, specialty physicians and ancillary providers for all product lines in assigned markets.
•Manages physician network by developing and maintaining contracting relationships to drive business results within a specific geographic area.
•Identifies strategies to achieve Medical Expense Initiatives (MEI).
•Performs ongoing research to identify new providers or areas of expansion in assigned market
•Responds to provider's contracts requests and inquiries.
•Analyzes network gaps and identifies providers to contract.
•Reviews and amends provider's contracts when necessary.
•Evaluates contracted network to ensure functionality.
•Assesses performance and contract rates of providers to ensure our network is cost efficient.
•Researches and develops relationships with non-contracted providers.
•Collects credentialing and required documents for newly contracted providers.
•Strategizes for membership growth and retention.
•Assists management on special projects and/or initiatives
•Performs special projects as assigned

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