Market Expansion Representative

WellCare Health Plans, Inc. provides managed care services targeted exclusively to government-sponsored healthcare programs, focusing on Medicaid and Medicare.  Headquartered in Tampa, Florida, WellCare serves approximately 808,000 members in Florida, New York, Connecticut, Illinois, Indiana, Louisiana and Georgia.  Nationally, WellCare provides stand-alone PDPs to more than 900,000 members in all 50 states under the Medicare Prescription Drug Program.  For more information about WellCare, please visit the Company?s website at www.wellcare.com.

 

We are looking to add a Market Expansion Representative to our team.  If you truly believe in teamwork, consistently demonstrate a high level of integrity and want to be part of a dynamic, growing organization, then this may be the opportunity for you!

 

Job Summary:

Manages physician network by developing and maintaining a specific geographic area. Achieves company targets through aggressive contract negotiations with primary care, specialty and ancillary providers in assigned county/counties.

 

Essential Functions:Contracts and negotiates with primary care and specialty physicians and ancillary providers for Medicaid, Medicare and Healthy Kids product lines. Manage the physician/provider re-credentialing process including (as needed) Site Survey visits. Work closely with the In-house Provider Relations staff regarding claims issues and contracting questions. Assist in the analysis of claim trend data and/or market information to derive conclusions to support contract negotiations.

 

Additional Duties:Identify network gaps and complete contracts. Routinely review out-of-network negotiations, identify providers for contracting, and complete contracting

 

Education/Experience: Bachelor?s degree is preferred Minimum of 1-3 years experience in Provider Relations Minimum of 1 year experience in government programs is preferred Sales/Contracting Experience a plus.

 

Communication and Numeric Skills: Excellent influencing and negotiating skills. Ability to explain complicated financial terms and utilization data to physicians and staff. Excellent written skills and the ability to speak publicly are essential. Must be organized and have excellent time management capabilities. Ability to analyze data in Excel to identify trends, and variance from goals.

 

Computer Skills:Advance Word and Excel knowledge Ability to learn internal systems, Diamond and Sidewinder

 

Other:Extensive out-of-office travel is required 50% of the time Driving 25% of time