Job Details

Medical-Network-Development-Representative-Entry-Level

Company name
Wellcare

Location
Tampa, FL

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Medical Network Development Representative (Entry Level)','1704468','!*!About WellCare: WellCare Health Plans, Inc. is a Fortune 500 company traded on the New York Stock Exchange (symbol: WCG). It provides managed care services targeted to government-sponsored health care programs, including Medicaid, Medicare, Prescription Drug Plans and the Health Insurance Marketplace. Headquartered in Tampa, Fla., WellCare offers a variety of health plans for families, children, and the aged, blind and disabled. The company serves approximately 4 million members and employs approximately 6,500 people nationwide as of Sept. 30, 2014. For more information about WellCare, please visit our website at www.wellcare.com or view our videos at https://www.youtube.com/user/WellCareHealthPlan.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.','!*!

LOCATION:  Henderson Road, Tampa, Florida

DEPARTMENT:  CNS – Network Expansions

REPORTING TO: Manager, Contract Implementations

 JOB SUMMARY

Promotes and markets the company to providers in new and expanding markets in support of market efforts to build networks. Solicits and reviews contracts for completeness and ensures supporting documentation is received based on the requirements of the provider type.  Answers incoming inquiries from providers including rate and other contract requirements and negotiations.

Key Duties and Responsibilities



Identifies and targets potential new provider relationships and, based on a market-specific action plan, solicits relationships and establishes leads regarding primary care and specialty physicians as well as ancillary providers and facilities for all product lines.



Conducts market research on providers in markets to help build and support physician recruiting campaigns.



Identifies and corrects issues with provider recruitment data.



Researches and resolves issues related to provider contracts, including rates and other contract requirements.



Outreaches to providers regarding outstanding contracts and other required documentation to include credentialing.



Negotiates basic rates and contract language based on established parameters. 



Reviews and processes incoming and outgoing paperwork related to network development.



Ensure new providers are loaded into the company's systems accurately



Tracks contract statuses and recruitment efforts to contribute information for status reports via Salesforce and other tools.



Evaluates GeoAccess issues and evaluates trend; makes recommendations to address them.



Escalates applicable provider issues to management as appropriate.



Supplies information that is used to generate GeoAccess reports and dashboards to track network adequacy and identify gaps.



Performs other duties as assigned.

MINIMUM QUALIFICATIONS

 

 

Education Level

Education Details

Required/Preferred

A High School or GED

 

Required

A Bachelor's Degree in a related field

 

Preferred

Work Experience

 

Experience Level

Experience Details

Required/Preferred

2 years of experience in

customer service or entry level inside sales

Required

2 years of experience in

Experience in network development, contract operations, health plan operations or provider relations

Required','US-FL-Tampa','8735 Henderson Rd','','Tampa','33634','','','No','No','Medical Network Development Representative (Entry Level)'

Company info

Wellcare
Website : http://www.wellcare.com

Company Profile
WellCare Health Plans, Inc. focuses exclusively on providing government-sponsored managed care services, primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, to families, children, seniors and individuals with complex medical needs. The company served approximately 3.8 million members nationwide as of Sept. 30, 2015. For more information about WellCare, please review our website and view the company’s videos. WellCare has developed a full complement of expertise in three major areas of government-sponsored health care…. Medicaid, Medicare Advantage and Medicare Prescription Drug Plans. Leveraging our expertise for our members' benefit is a key part of the value we bring to our members. WellCare focuses on those members who are dually eligible for both Medicaid and Medicare. This is an area of specialization that many other health plans simply do not have. We are committed to continually improving the quality of care and service that we provide to our members. We help our members access the right care at the right time in the appropriate setting. For some members, this includes the use of coordinated care teams and community partnerships. And we’re focused on government customers and use a disciplined approach to ensure a competitive cost structure.

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