About the position
At WelbeHealth, we are transforming the reality of senior care by providing an all-inclusive healthcare option to our most vulnerable senior population by serving as both a care provider and care plan to the participants we serve. Our Health Plan Services team is making it possible for our seniors to receive top-quality clinical care within their communities. The Network Development Manager plays a crucial role in this mission by obtaining and developing provider partnership contracts (Medicare & Medi-Cal) in our existing and future markets to best serve our participants' elaborate care needs. This position will manage our Northern California market locations, including San Jose, Stockton, Modesto, and Fresno. The Network Development Manager will regularly assess and meet participant needs for provider contracts across PACE programs in WelbeHealth and help build a specialty-based provider network across our Southern California territories. This involves preparing contract templates and negotiating optimal rates within Medi-Cal/Medicare and value-based environments across varying methodologies, including specialties, hospitals, ancillaries, skilled nursing facilities, and nonstandard PACE providers. Additionally, the manager will coordinate post-contract implementation and contract loading with cross-functional teams and market-based leadership, establishing strong relationships with contracted partners to ensure their satisfaction.
Responsibilities
- Regularly assess and meet participant needs for provider contracts across PACE programs in WelbeHealth.
- Build a specialty-based provider network across Southern California territories.
- Prepare contract templates and negotiate optimal rates within Medi-Cal/Medicare and value-based environments.
- Coordinate post-contract implementation and contract loading with cross-functional teams and market-based leadership.
- Establish strong relationships with contracted partners and ensure partner satisfaction.
Requirements
- Minimum of three (3) to five (5) years of experience in contract negotiation, managed care, healthcare administration.
- At least three (3) years of direct experience in Medicare/Medi-Cal contracting required.
- Ability to comprehend and oversee contracting across varying regulatory environments and requirements.
- Proven success leading network development efforts as a new entrant health plan.
- Bachelor's degree preferred, or an additional four (4) years of experience in lieu of education.
- Local to the greater Northern California region with the willingness to travel on-site as needed.
Nice-to-haves
- Experience in healthcare administration or managed care settings.
- Familiarity with value-based care models.
- Strong negotiation skills and relationship management experience.
Benefits
- Medical insurance coverage (Medical, Dental, Vision) starting day one of employment.
- 17 days of personal time off (PTO) and 12 holidays observed annually.
- Sick time and work/life balance initiatives.
- Advancement opportunities with a track record of hiring and promoting from within.
- 401k match and a competitive total rewards package.
