Why Wellmark: We are a mutual insurance company owned by our policy holders across Iowa and South Dakota, and we’ve built our reputation on over 80 years’ worth of trust. We are not motivated by profits. We are motivated by the well-being of our friends, family, and neighbors–our members. If you’re passionate about joining an organization working hard to put its members first, to provide best-in-class service, and one that is committed to sustainability and innovation, consider applying today! 

Learn more about our unique benefit offerings here. 

Want to know more? You can learn about life at Wellmark here.

About the role: In this role, you will lead a team of Behavioral Health Case Management clinicians focused on assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s health needs through communication and available resources to promote quality cost-effective outcomes to members enrolled with Wellmark. Provide planning, leadership, and situational guidance to staff, ensuring member/customer inquiries and issues are resolved timely and accurately for an optimal member experience. Serve as a clinical resource for complex or escalated issues. Continuously promote and support an environment of teamwork, focus on the member, continual learning and improvement and efficient and effective work processes, while focusing on maximizing team member strengths.

About You: Because this role will be a leader of others, this individual will directly impact the success, growth, and development of team members by setting clear expectations, defining accountabilities, providing regular coaching, facilitating change, and providing an overall positive work environment. Being a role model in behaviors that demonstrate Wellmark’s core competencies and leader model is a must. In addition to outstanding leadership skills, ideal candidates are registered nurses who are passionate about providing care to others, and they’re eager to find new ways to do so – the opportunity to broaden their clinical expertise and proactively help members navigate the complexities found within the health care system are what fuels their purpose. Experience with motivational interviewing would be a value add.  The work won’t always come easy and change will be involved, so creativity, flexibility, resiliency, dedication, self-motivation, and a positive outlook are essential to success. Our teams thrive in a dynamic, fast-paced environment, so a collaborative approach is a must.

Top candidates will have 4+ years of clinical behavioral health experience, as well as experience building and standing up clinical programs. Data analysis, case management, formal leadership and health plan experience are a plus!

Candidates in Iowa or South Dakota preferred.

Required:

• Active and unrestricted Registered Nurse (RN) license in Iowa; individual must be licensed in the state in which they reside.
• Completion of an accredited RN program.
• Certified Case Management (CCM). Must attain the certification within 24 months of hire.
• 4+ years of diverse clinical experience (e.g., acute care, outpatient, home health, etc.) in a health care, health insurance, or similar work environment that reflects: a minimum of 4 years of direct clinical care to the consumer; Management of Case Management Cases with increasing levels of accountability; demonstrates a proactive approach and ability to think ahead in a patient’s/member’s needs; Track record of success leading initiatives, projects, or programs.
• Proven formal or informal leadership experience. Ability to lead, coach, engage, and develop team members in a dynamic/changing work environment where member experience, production, quality, and outcome goals are monitored, measured and reported on.
• Demonstrated commitment to service excellence and advocacy for member care.
• Ability to operate with agility and flexibility; effectively moves from strategy to tactics to operations.
• Strong verbal and written communication skills, including the ability to coach, influence action, and facilitate crucial conversations. Timely submissions of escalation and briefing documents.
• Proactive, resourceful self-starter. Strong understanding of resources, processes, and guidelines. Independently makes decisions and develops recommendations.
• Balanced, yet creative approach to process improvement and problem solving. Thinks critically, uses data/information, creates structure, and keeps the member in mind.
• Develops collaborative relationships with peers, team members, and stakeholders. Viewed as a trusted, inclusive partner.
• Strong technical acumen; learns new systems quickly - e.g. Microsoft Office, clinical documentation platforms, etc.

Preferred:

• Master’s degree in Nursing or related field.
• Formal leadership experience.
• Prior experience identifying and implementing member engagement strategies in case management.
• Knowledge of regulatory standards and regulations – e.g., NCQA, URAC, HIPAA, PHI, confidentiality

a. Provide oversight and lead a Case Management clinical team to support member use and navigation of the health care system improving member outcomes, health care cost management and optimal member engagement and experience.

b. Provide leadership and day-to-day management of financial and human resources, primarily focusing on employee coaching, development, performance improvement and coordination. Support Wellmark strategies and tactics, business objectives and produce results that are effective, accurate, timely and on target to meet member, business and stakeholder needs.

c. Clinical Guidance: Serve as a clinical resource subject matter expert for team members and provide guidance in working through complex situations. Collaborate with members/families and with other Wellmark leaders and staff as needed to support a seamless member engagement and experience while ensuring member needs are addressed.

d. Develop, implement, and maintain effective and efficient policy standards and business processes that support and enhance the clinical team functions and quality of healthcare services. Identify, document, and resolve operational barriers that may interfere with the timely, efficient and compliant interactions with members/families and providers.

e. Assure processes are in compliance with all accreditation standards e.g., NCQA, Kansas URO Certification (including quality improvement initiatives), local and state regulations, and internal guidelines.

f. Lead and/or participate as a subject matter expert in projects related to Health Services programs. Collaborate and participate in joint educational sessions with stakeholders and customers representing Health Services.

g. Other duties as assigned.

Remote Eligible: You will have the flexibility to work where you are most productive. This position is eligible to work fully remote. Depending on your location, you may still have the option to come into a Wellmark office if you wish to. Your leader may ask you to come into the office occasionally for specific meetings or other ‘moments that matter’ as well.  

An Equal Opportunity Employer

The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.

Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at [email protected]