Job Description

Serves as a strategic, highly visible key leader in the representation of Wellmark across the provider network to effectively meet the needs of our clients, members, providers, and other stakeholders. Develops and maintains positive, professional relationships and collaboration with physicians, hospital leaders, clinic administrators, and other healthcare professionals. Develops and maintains positive, productive, professional relationships with healthcare organization leaders (i.e., Iowa Hospital Association, South Dakota Association of Healthcare Organizations, Iowa Medical Society, Healthcare Financial Management Association, etc.). Leads the Provider Relations team with overall accountability in building and maintaining strong, positive relationships with providers participating in Wellmark’s networks. Oversees and directs a network relationship service model that focuses on managing escalated issues and educating and communicating with network providers about strategic initiatives to improve quality, efficiency of care, and administrative performance by providers. Will collaborate and partner with Network Payment Strategy, Network Performance, Health Services, Operations, and other internal stakeholders that affect the relationships with network providers. Creates customer value and competitive advantage through enhanced provider relations which, when coupled with enhanced medical/benefit management techniques, improves health status and provides affordable and accessible health care products and services to customers.

Qualifications

Education

• Bachelor's degree in healthcare, business, or other related area, and/or direct and applicable work experience.
• Advanced degree in healthcare or business (MBA, MPH, MHA, etc.) strongly preferred.

Experience

• Minimum of 7–10+ years of health insurance, managed care, State or Federal health program, or related industry experience that includes demonstrated relationship management skills with the proven ability to develop positive, long-term relationships with hospital, physician, and other healthcare leadership and/or personnel that promote positive and influential provider relations, effective negotiation and marketing capabilities.
• Prior experience working in both commercial and government program sectors is preferred.
• Subject matter expertise in network development, contracting, risk sharing, and the development and implementation of innovative value-based contracting and alternative payment models.
• Understanding of and experience working with regulators at the state and federal levels (CMS, CMMI etc.) preferred.
• Demonstrates knowledge concerning how organizations function and can get things done through formal and informal channels and networks.
• Demonstrated leadership experience, leading leaders, partnering in a matrix environment, and developing high performing collaborative teams.
• Strong analytical, critical thinking, problem solving and research skills; uses data to inform decisions. Creative approach to continuous improvement and optimization.
• Strong consulting skills. Balances expertise and business acumen with understanding of customer/stakeholder needs.
• Develops collaborative relationships with executives, divisional leadership and operational teams resulting in the consistent development and delivery of strategic business planning solutions. Effectively influences others and resolves conflict.
• Exceptional written and verbal communication skills. Effectively articulates business implications and actionable recommendations to varying audiences, including executives. Strong presentation skills.
• Strong organizational skills and attention to detail. Skilled at moving from strategy into tactics. Establishes clear goals/expectations, aligns resources, and motivates teams in order to achieve success.
• Proactive and adaptable with strong change management skills. Effectively coaches and leads teams through change.
• Proficiency with Microsoft Office applications, such as Word, Excel, Outlook, PowerPoint, or Access.

Additional Preferred Qualifications

• Previous experience within the provider network or health system and the ability to bring forward ideas and drive strategies to support the network; partner and think broadly across all networks and providers to drive provider alignment and enhancements.
• Knowledge of contracting and payment strategies, medical policy, benefit designs and product offerings.
• Reside in either Iowa or South Dakota.

TRAVEL

• 15%–20% of the time, including some overnight stays. Valid driver’s license required.

Additional Information

• Oversee and direct a network relationship service model, focused on provider relationships, that aligns with the corporate and divisional strategies and objectives. Oversee long term goals and measures that are consistent with these strategies and objectives.
• Implement strategies to support Wellmark’s relationships with network participating providers as well as provider communication and education efforts. Will influence providers to act and produce measurable outcomes relative to improving quality, efficiency of care, and administrative performance.
• Provider Relationship Management: Develop strong, collaborative business relationships and establish face-to-face interactions with providers, strategic healthcare organizations, physicians, hospitals, health care practitioners, health systems, physician, provider and/or hospital organizations, medical societies, hospital associations, and healthcare organization leaders in Iowa and South Dakota to make the voice of the provider heard at Wellmark and provide an avenue to effectively communicate and interact with Wellmark.
• Assist with and collaborate on progress towards the development and implementation of value-based contracting programs and alternative payment models with the provider community.
• Provide day-to-day leadership of financial and human resources, primarily focusing on employee and leader coaching, development, performance improvement, coordination and budgeting for multiple staff, and department(s) specific functions/services.
• Provide oversight of activities that support positive physician/hospital relationships with a focus on a data driven, collaborative approach. Ensures collaboration with network providers in order to identify and execute on mutually beneficial initiatives that produce measurable outcomes on key administrative performance metrics.
• Develop relationships and represent Wellmark on both a state and national level in order to influence policy development and information sharing. Ensure activities conducted within the Provider Relations Department are in compliance with NCQA guidelines, the Public Exchange or other accrediting standards, compliance, department policy, and/or state and federal law.
• Ensure the on-going professional development and implementation of effective and timely provider communications, education, and training programs.
• Collaborate and build trusted relationships with Wellmark stakeholder. Ensure close partnership with various areas including Network Payment Strategy, Network Performance, Health Services, Operations, and other internal departments that initiate programs or projects that impact network providers.
• 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