RaleighRecruiter Since 2001
the smart solution for Raleigh jobs

Chief Operating Officer - North Carolina - Raleigh

Company: Wellcare Health Plans
Location: Raleigh
Posted on: September 15, 2019

Job Description:

Responsible for the overall operations of the health plan, including strategic direction, administration for all existing programs and the development of new programs to ensure goals and objectives are met or exceeded. Working closely with WellCare's executive leadership team, leads and directs the overall improvement of operations including: provider contracting and relations, sales and marketing, medical management, regulatory compliance and finance, as well as interfacing with corporate office operations. Serves as the representative of the health plan to government entities and other external agencies and ensures compliance with all relevant regulatory agencies.Reports to: State PresidentDept.: NC Exec StateLocation: Raleigh, NCEssential Functions:Leads and directs the day to day operations of the health plan. This includes providing leadership and direction to the management team to ensure the organization's strategic plan is translated into tactical goals and objectives that guarantee performance objectives are met or exceeded.Directs and manages the organization's financial performance. Takes appropriate actions to increase revenue, leverage resources, manages and/or minimizes expenses and ensure compliance with all business and administrative regulations.Directs the development of annual budgets and presents the budgets for approval.Assist and leads where appropriate, with aspects of state and federal government relationships, including dealing with regulators, as necessary, to establish and continue effective working relationships. Ensures that all state and federal regulations are met.Oversees the development and maintenance of a viable provider network to ensure the health care needs of WellCare members. Develops and manages provider contracts and partnerships to achieve quality and cost management objectives. Works closely with providers to enhance relationships and maximize their ability to effectively manage the cost of medical delivery.Oversees the development, implementation and continuous evaluation of the utilization and quality management program for medical services delivered by contracted health care providers.Oversees the development and implementation of short and long term sales and marketing plans.Leads organizational development activities that develop and foster strong working relationships among the members of the management team. Builds and promotes the culture of the plan to be consistent with the values established by the corporate office.Establishes formal and informal mechanisms to promote and maintain credibility, competence, and a positive corporate image by exhibiting strong communication to the corporate office, providers, members and committees.Develops and implements key components of business strategyDevelops new models and processes to meet future business needsSets company prioritiesEstablishes reporting systems and controls to ensure compliance with company requirementsRecommends, develops, and aligns policies and procedures with company objectivesProvides problem analysis and problem resolution at both a strategic and functional levelRecommends and leads improvement processes and initiativesThis position is contingent upon the bid award in the state of North Carolina to WellCare Health Plans, Inc.Education/Experience:Bachelor's degree in business administration, finance or a related field, with a master's degree strongly preferredSuccessful track record in: Provider Relations, ownership of top and bottom line P&L responsibility with a successful HMO (government program experience preferred), growing membership and revenue, and improving the MLRExtensive experience in provider contractingMinimum of five to seven years of senior management experience with P&L accountability for a managed care organizationBroad knowledge of the managed care industry and proven experience leading governmental programs.Comprehensive knowledge of delivery system operations, provider contracting, strategic planning and overall service deliveryPowerful leadership skills with a vision and understanding of the future and subsequent changes required to meet business needsSales background preferred with ability to motivate a sales forceAbility to retain confidentiality regarding privileged company informationProvides proactive approach and support to emerging business activities established to remain competitive in the marketplaceProven ability to affect change and meet business goals, monitor progress and take corrective actions when necessaryComputer Skills:Knowledge of Microsoft Office including Word, Excel, Outlook ExpressKnowledge of and/or ability to utilize COGNOS for budgetary decisions or review.Other:An extremely organized, disciplined, hands on and process oriented leader who is not afraid of digging into details when necessaryA "failure is not an option" mentality and demonstrated proactive management style.Strong business acumen, intelligence, and capacity. Thinks strategically and implements tactically.Problem solves and approaches work from a "return on investment" perspective.Able to work in a matrixed reporting environmentAbility to work in a high energy, fast paced and data driven environmentHighly Flexible regarding schedules, priority shiftsAbility to think creatively and out of the box.Ability to remain calm under pressure.About usHeadquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.

Keywords: Wellcare Health Plans, Raleigh , Chief Operating Officer - North Carolina - Raleigh, Executive , Raleigh, North Carolina

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Executive Jobs


Restaurant General Manager
Description: DescriptionTo eat. To laugh. To share. That's why people come to Pizza Hut. It's the calling of our Restaurant General Managers to make them feel like family with smiles, teamwork and dedication. If you're (more...)
Company: Pizza Hut
Location: Raleigh
Posted on: 09/23/2019

Client Success Manager
Description: Keen is looking for a talented, ambitious, results oriented individual that is committed to the success of our clients. In this role you will oversee onboarding, training, support, and work towards building (more...)
Company: Keen Decision Systems
Location: Durham
Posted on: 09/23/2019

Emergency Medicine Physician (Medical Director) (Physician #)
Description: br No Visa' s. BE/BC Emergency Medicine physician or Family Medicine physician with ED experience. FT and PT opportunities are available. Highlights include: --- Close proximity to NC and VA beaches (more...)
Company: Spot On Recruiting, Inc.
Location: Raleigh
Posted on: 09/23/2019


Associate Director, Global Execution Systems
Description: br Associate Director, Global Execution Systems br br Job Description br br This leader in the global process automation group is responsible for all process automation systems and manufacturing (more...)
Company: Cameron Craig Group
Location: Raleigh
Posted on: 09/23/2019

Admissions and Program Marketing Manager
Description: Recruits undergraduate and graduate students in the USA, Canada South American territories for all campuses but with a large focus on domestic recruitment of students
Company: SKEMA Business School - US Campus
Location: Raleigh
Posted on: 09/23/2019

BC/BE Pathology Medical Director - 4 hours per Week - Raleigh, North C
Description: Immediate opening for a part time, Contract Physician - Alternate Center Medical Director for plasma donor center - Just 4 hours per week can be all at once or multiple visits - Must be a board certified (more...)
Company: Integrity Healthcare
Location: Raleigh
Posted on: 09/23/2019

Senior Account Manager
Description: Description: br OverviewThis role will manage the sales and marketing relationship between MetaMetrics and its assessment partners and forge key partnerships with sales and marketing personnel within (more...)
Company: MetaMetrics, Inc
Location: Durham
Posted on: 09/23/2019

Senior Project Manager
Description: Client: State of North Carolina Role: Senior Project Manager Location: Raleigh, NC Duration: 10 to 12 Months Either Webcam Interview or In Person Required Skills: 10 years Project management (more...)
Company: Gateway Solutions Inc
Location: Raleigh
Posted on: 09/23/2019

District Sales Manager
Description: District Sales Manager We are seeking a hands-on District Sales Manager to support in-store client programs. In this key leadership role, the District Sales Manager is responsible for sales, training (more...)
Company: Advantage Solutions
Location: Durham
Posted on: 09/23/2019

Project Management Specialist - Center for Forensic Science
Description: The Center for Forensic Science CFS leads programs that enhance the effectiveness and reliability of forensic science organizations and related practitioner communities. In partnership with a diverse (more...)
Company: RTI International
Location: Durham
Posted on: 09/23/2019

Log In or Create An Account

Get the latest North Carolina jobs by following @recnetNC on Twitter!

Raleigh RSS job feeds