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! 

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Are you a leader with a passion for driving healthcare transformation? Join our team as a Medicare Advantage Provider Performance Leader and help shape its future at Wellmark! 

About the Role: As a leader in our Medicare Advantage provider performance area, you will play a key role in advancing a dynamic, fast-growing line of business. This is your chance to bring your entrepreneurial spirit, innovative thinking, and healthcare expertise to an evolving product line. On a day-to-day, you will lead a team committed to building and maintaining strong relationships with key healthcare organizations, physician groups, and other external stakeholders, all while driving results that enhance quality of care and reduce costs for our members. You will provide visionary leadership to develop and execute strategies that improve Medicare Advantage provider performance, which includes collaboration with joint venture partners and key internal stakeholders (e.g. Network Performance, Network Payment Strategy, Health Services, Legal, Marketing & Communications, and others) to achieve organizational goals. By leveraging your strong analytical skills, you will make informed decisions and drive continuous improvement that ensures alignment with overall plan performance, quality improvement, and cost management of our MA network programs.  

Because this role will be a leader of others, you will directly impact the success, growth, and development of team members. It is critical that you are a role model for behaviors that demonstrate Wellmark's core competencies and Leader Success Expectations which includes setting clear expectations, defining accountabilities, providing regular coaching, facilitating change, and providing an overall positive work environment. In addition to outstanding leadership skills, you have a passion for healthcare and leading positive change.

About You: Ideal candidates thrive in a startup-like environment, have proven experience in implementing enterprise-wide strategy, analytics, and program management, and a demonstrated history of cultivating and maintaining strong relationships internally and externally. You possess a deep understanding of Medicare Advantage network dynamics and performance improvement, applying a results-driven mindset that will optimize plan and provider performance. Lastly, you have exceptional organizational change management capabilities, with a track record of driving impactful transformation. 

Why You Should Join Us: By joining our Medicare Advantage team, you will have the opportunity to significantly impact healthcare's future. You will be a part of a team where innovation, agility, and new ideas are encouraged and celebrated. Your leadership will directly contribute to improving the quality of care for Medicare beneficiaries, optimizing network performance, and positioning our organization as a leader in Medicare Advantage. Check out our opening and apply today! 

*This position will work a hybrid schedule of at least 3 days in Wellmark's Des Moines office, with 2 days remote option. As a leader, there may be additional days in the office to meet business needs. 

**The internal title for this role is Team Leader Medicare Advantage Network Performance. For the sake of clarity, we have largely replaced 'Network' with 'Provider' in this posting. They are used interchangeably at Wellmark. 

Required:

• Bachelor’s degree or direct and applicable work experience.
• 4+ years of related healthcare industry experience that reflects analysis of health care quality data, financial data, business strategy development and network performance management.
• Strong abilities in the interpretation of data (e.g. outcomes, trends, assessment of benchmark data). Demonstrated problem-solving, quantitative, and analytical skills with the ability to recognize inconsistencies, analyze for reasonableness and accuracy, research and come to conclusion in a wide variety of changing analytical situations.
• Ability to build and maintain strategic, ongoing relationships with colleagues and external stakeholders – e.g., health care organizations, physicians, physician aggregators, hospitals, and Accountable Care Organizations.
• Leadership skills typically gained through a combination of project or informal leadership that demonstrates knowledge of work processes, products and services, and leadership competencies.
• Proven skills in motivating and influencing others; ability to build collaborative relationships across the organization.
• Effective consultation skills, including the ability to persuade and influence key decision makers.
• Demonstrated ability to communicate effectively verbally and in writing, expressing complex concepts clearly and concisely with multiple levels of an organization, including external stakeholders and professional organizations. Ability to develop and facilitate presentation as needed.
• Ability to apply strong analytical, problem solving, and critical and strategic thinking to work with vendors and internal departments. Willingness to take an innovative, creative approach to solving problems and developing solutions.
• Self-starter motivated by the opportunity to work in fast-paced environments and driven by measurable outcomes. Ability to operate independently yet cooperatively on teams to appropriately manage priorities while maintaining positive relations.
• Strong organization, time management, and prioritization skills. Ability to manage multiple projects while adjusting to changing priorities and business needs.
• Ability to develop and maintain documentation of processes and procedures and make decisions by following established guidelines.
• Proficiency with Microsoft Office applications, such as Word, Excel, Outlook, PowerPoint or Access.
• Ability to travel up to 10% of the time, including overnight stays. Valid driver’s license required.

Preferred:

• Previous value-based contracting experience.
• Experience with provider quality, outcomes and risk adjustment initiatives strongly preferred.
• Knowledge of contracting and payment strategy, medical policy, benefit designs and product offerings.

a. Provide leadership and day-to-day management of financial and human resources, primarily focusing on employee coaching, development, performance improvement, coordination and budgeting for staff and department(s) specific functions/services. Support business objectives and produce results that are effective, accurate, and timely and on target to meet HR team and stakeholder needs.

b. In collaboration with division and joint venture leadership, define, shape, and drive the Network Performance strategies inclusive of coding accuracy, Medicare Stars, and cost of care. 

c. Lead a team responsible for network performance relationship management, value-based provider contracting, and financial incentive   operations. Provide ongoing monitoring and management of provider performance opportunities for total cost of care and quality benchmarks related to value-based payment initiatives and ensure strategic focus is on target with overall company strategy.

d. Develop health care organization and other strategic provider relationships by conducting management and joint operating committee meetings and presenting as needed in order to effectively review value-based contract compliance and performance. Recommend strategies and specific actions to improve managed care performance.

e. Negotiate competitive and complex, value-based contractual relationships with key health care organizations, physicians, physician aggregators, and strategic stakeholders according to Wellmark guidelines and quality and financial standards.

f. Oversee and drive strategic initiatives for Wellmark’s relationships with key health care organizations and other strategic stakeholders.

g. Oversee the management of end-to-end processes across Medicare Advantage Network Performance programs and lead the development and maintenance of provider financial incentive models.

h. Partner with internal and external partners to support network performance analytics and reporting.

i. Continually assess external environment and emergence of value-based contracting and network performance activities and implications for Wellmark, including analyzing and preparing information to facilitate decision-making.

j. Ensure staff are versed in best practices and of value-based payment and healthcare trends. Provide direction to ensure objectives and outcomes are met, interactions are relevant and engaging for the audience.

k. Other duties as assigned.

This job requires a non-compete agreement.

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]

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