Provider Relations Rep - Bowling Green Job Listing at WellCare Health Plans in Louisville, KY (Job ID 1402456)

WellCare Health Plans

WellCare Health Plans

Location: Louisville, KY
Application deadline: None
Type: Not specified
Career Level: Associate
Salary Range: Not specified
Number of Jobs: 1
Relocation Available: No
Show all jobs for WellCare Health Plans
Insurance, Healthcare
Provider Relations Rep - Bowling Green-1402456

About WellCare: WellCare Health Plans, Inc. provides managed care services targeted to government-sponsored health care programs, focusing on Medicaid and Medicare. Headquartered in Tampa, Fla., WellCare offers a variety of health plans for families, children, and the aged, blind and disabled, as well as prescription drug plans. The company serves approximately 3.3 million members nationwide as of January 1, 2014. The company employs more than 5,100 nationwide. For more information about WellCare, please visit the company's website at A Fortune 500 company traded on the New York Stock Exchange (symbol: WCG).

EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, sex, age forty (40) and over, disability, veteran status, or national origin.  Description   Manages physician network by developing and maintaining relationships to drive business results within a specific geographic area.  Provides service and education to network physicians/providers.  Achieves company targets through implementation of Network Improvement plans.
Essential Functions: 

  • Completes new provider orientation for all applicable product lines.
  • Conducts site visits to service providers, resolve issues, educate staff/providers on policies, collect credentialing information, and review HEDIS information.
  • Achieves call reach and frequency goals to establish consistent and strong relationship with provider offices.
  • Provides oversight on inquiries and claims issues and follows up with providers to ensure problems have been resolved.
  • Supports regional Network Improvement Plan targets by providing utilization reports, pharmacy profiles, ER contingencies, Frequent Flier Reports and other analytics available to improve /maintain regions.
  • Identifies network gaps and completes contracts or works with Network Development.
  • Understands and explains risk contracts.
  • Strategizes for membership growth and retention.
  • Provides oversight of delegated functions as applicable.
  • Special projects as assigned or directed
Qualifications   Education:  Bachelor's degree preferred or equivalent directly related experience
Experience:  Minimum one (1) year experience in Medicaid/Medicare is preferred.  Pharmacy, healthcare, provider or HMO/PPO background preferred.
Special Skills (e.g. 2nd language):  Excellent problem solving skills.  Excellent oral and written communication skills.  Must be organized and have excellent time management capabilities.  Ability to analyze data to identify trends, and variance from goals.

Primary Location  KY-Louisville Travel  Yes, 50 % of the Time

Is a relocation package available? No

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