Job Description

Use your strengths as a Provider Performance Manager – Medicare Advantage at Wellmark!

About the Role: As a Provider Performance Manager for Wellmark’s Medicare Advantage (MA) plan, you will develop and maintain strong, positive relationships with key health care organizations to optimize performance of Wellmark’s Medicare Advantage Stars, quality, cost of care and clinical risk programs. You will leverage these relationships to inform, develop and drive collaborative action plans and performance outcomes, supporting the evolution of efficient total cost of care focused value-based payment, quality, and risk programs. With this as a foundation, you will be responsible for facilitating, supporting, and coordinating strategic initiatives with key health care organizations in support of driving improved quality and efficiency of care. You will leverage your experience in data analytics & insight development, process management, quality improvement, organizational change management and provider relationship management to drive key results.

About you: Using your healthcare and/or MA knowledge, and a passion for making health care better, you are at your best when you can balance your analytical side with your collaborative side. You have a knack for building and managing relationships alongside multiple priorities. You have strong communication skills, including a keen ability to effectively communicate complex information in a compelling manner to influence decisions. You are comfortable delivering a formal presentation to healthcare executives and internal stakeholders, with the ability to adjust to various audiences quickly. You are detailed and thorough with the ability to effectively communicate insights from data. For you, solving a complex problem means being innovative and creative; asking all the right questions and effectively digging into the data along the way. From time-to-time there may be difficult conversations to work through, but the variety and challenge drives you! While you will have autonomy in this role, this is an opportunity to join a highly collaborative and integrated team!

If this sounds like you and you’re ready to join Wellmark's mission to make health care better, apply today!

This position will work a hybrid schedule of at least 3 days in Wellmark’s Des Moines office, with two days remote option.

Internal Job Title: Network Performance Manager – Medicare Advantage

Qualifications

Required Qualifications:

• Bachelor's degree or direct and applicable work experience.
• 4+ years of related healthcare industry experience that reflects analysis of health care quality data and network management or provider relations.
• Demonstrated ability to think strategically to ensure program success.
• Demonstrated experience influencing stakeholders.
• Excellent analytical skills, data management capabilities, and strong attention to detail. Ability to review data and provide measurable outcomes and trend measures to support and influence business decisions.
• Technical aptitude to learn new data management and analysis tools or methodologies quickly.
• Strong analytical, problem solving, and critical and strategic thinking skills. Willingness to take an innovative, creative approach to solving problems and developing solutions.
• Strong written and verbal communications skills with the ability to share technical insights and recommendations with varying stakeholder audiences, including healthcare providers and external vendors. Adapts communication based on audience.
• Self-starter motivated by the opportunity to work in fast-paced environments and driven by measurable outcomes. Effective time management with flexibility and adaptability to change.
• Strong organization, time management, and prioritization skills. Ability to manage multiple projects while adjusting to changing priorities and business needs.
• Collaborative approach to work with and ability to partner with different business areas.
• Proficiency with the Microsoft Office Suite.
• Ability to travel within the state of IA/SD up to 50%, if needed.

Preferred Qualifications:

• Knowledge of CMS Star Rating measures, clinical standards of care, preventive health, and risk adjustment.
• Knowledge of CMS rules and requirements of Medicare Advantage health plans.
• Knowledge of value-based care landscape.
• Knowledge of industry standard ICD-10-CM and CPT coding principles.

Additional Information

What you will do as a Provider Performance Manager - Medicare Advantage:

a. Establish positive, long-term, consultative relationships with key healthcare organizations.

b. Develop and implement Medicare Advantage network strategies that support Star Rating quality measures, risk adjustment, and provider incentive programs.

c. Analyze healthcare organization quality and risk program performance data to identify and prioritize provider outreach strategies to help achieve quality and risk program targets.

d. Partner with internal stakeholders and/or external vendors in the definition, design, implementation, and maintenance of data files and data extracts to meet quality reporting needs of Wellmark’s Medicare Stars and clinical risk initiatives.

e. Develop comprehensive, provider-specific action plans to increase Stars and quality performance, facilitate clinical documentation improvement and improve practice outcomes.

f. Provide value-added consulting, training, and coaching to assigned healthcare organizations while focusing on the long-term goals of the organizations and Wellmark.

g. Prioritize activities that support corporate initiatives related to health care organization engagement, quality, and efficiency of care.

h. Lead clinical and financial performance committees with healthcare organizations to drive action plans, continual process improvement and achievement of performance goals.

i. Negotiate competitive and complex, value-based contractual relationships with health care organizations according to Wellmark guidelines and quality and financial standards.

j. Responsible for the implementation of new Medicare Advantage value-based models and/or changes to existing value-based models with health care organizations.

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

l. Advise Medicare Advantage leaders on provider engagement best practices and provider incentives.

m. 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 atcareers@wellmark.com

Please inform us if you meet the definition of a "Covered DoD official".