Network Coordinators, WellMed - Pasco or Hernando Counties, FL - Full-time / Part-time

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The Network Coordinator is responsible for developing, maintaining and servicing a high quality, marketable and satisfied provider network within an assigned geographic area. Key responsibilities include support and education for contracted physicians and ancillary providers. The Network Coordinator helps assigned primary care physicians operate successfully within the healthcare delivery model in support of enterprise goals. This position works closely with local marketing and medical staff, as well as corporate support functions. This position is expected to maintain strong working relationships with assigned physicians, hospitals and ancillary providers.

Primary Responsibilities:

• Under the direction of the Manager, PBS, works closely with contracted PCPs to ensure they have the tools they need to meet Quality Metric goals including DataRaps and FOC


• Complete detailed analysis of Quality Metric reports and track data at the patient level to ensure new members are seen within 90 days, all members seen annually and completion of the actions needed to meet the remaining quality metrics. Provide physician and office education to improve metrics as needed


• Participate in creation and execution of a local network development plan to assure network adequacy


• Meet regularly with contracted providers and staff to review metrics and ensure appropriate tools and resources are available and utilized


• Conduct new provider orientations and deliver in-service training to educate providers and their staffs on PHC products, processes and compensation arrangements


• Maintain open communication with providers on health plan issues related to claims, eligibility, RAPS, disease management, utilization management, reimbursement and quality programs


• Collaborate with market leadership to monitor utilization trends and profit pools and share results with assigned PCPs


• Resolve provider and member specific issues related to claims, eligibility and referrals


• Handle scheduling, agenda, materials, location, meals and minutes of provider meetings as needed


• Work closely with contracting team to ensure provider data is correct and Provider directories include any needed updates. Complete appropriate forms as needed


• Provide information and participate in management meetings as requested


• Perform all other related duties as assigned 

 Position will require travel - 75%. Positions are in Tampa but will cover one of two areas: Pasco County or Hernando County.
Looking for candidates that will primarily be a telecommuter with the requirement to come to the Tampa corporate office at least once per week.

Required Qualifications:  

• 3+ years of provider relations experience


• 2+ years of experience working with a broad range of  healthcare professionals including, but not limited to: providers, physicians, hospital executives, office staff, and other health plan staff


• 2+ years of experience working with analytics in a managed care environment


• Community healthcare knowledge for the Greater Tampa area


• An intermediate level of skill working with data in Microsoft Office (Excel)

Preferred Qualifications:  

• Bachelor's degree  

WellMed is a healthcare delivery system serving more than 90,000 patients, primarily Medicare eligible seniors, in Texas and Florida through primary care clinics, multi-specialty clinics, and contracted medical management services. Headquartered in San Antonio, Texas, WellMed is an industry leader in medical risk management, highly effective disease management and chronic care programs, healthcare delivery services and more.

Our focus and mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. We are innovators in preventative healthcare, striving to change the face of healthcare delivery for seniors. Our providers and support staff are selected for their dedication to the senior population and focus on preventative, proactive patient care.

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.