Network Development Mgr Sr - 19628AP

WellPoint is the nation's leading health benefits company serving the needs of approximately 28 million medical members nationwide.



Duties and Responsibilities:

Responsible for serving as a contract negotiator and liaison between hospitals and "at risk" medical groups and the company for a specific health service area. Essential duties to include, but are not limited to: Negotiates contracts with hospitals for all networks including traditional, PPO, HMO, CHAMPUS, transplants, carveout networks, and hospital based ancillaries. Negotiates risk sharing contracts, monitor future activities of providers, keeping abreast of trends and changes within the group. Reviews and analyzes financial data, hospital utilization reports, NCQA and URAC standards and M&R benchmarks. Works closely with corporate contracting, legal and actuarial staffs. Performs other duties as assigned.



Requirements and Qualifications:

BS/BA in business, health administration, or other clinical field required. MBA or CPA preferred. Extensive knowledge of provider reimbursement methodologies including DRG's, per diems, case rates, etc. preferred. 3 years of hospital contracting experience required. Excellent analytical skills, strong PC skills required. Strong planning and organizational skills required. Strong negotiation skills required.