Director – Provider Network Development & Contracting

Company Description

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.

Job Description

About the opportunity: Wellmark’s Director of Provider Network Development & Contracting will provide leadership and strategic direction for Wellmark’s provider network development and contracting, network innovation analytics, network intelligence, and commercial network performance teams. This Director will have overall accountability for the design, implementation, and execution of complex provider network strategies for physician, hospital, and all other health care entities to ensure alignment with our divisional and corporate objectives, focusing on total cost of care for our members. This role will actively partner with multiple areas of the division and broader organization, including Network Economics, Provider Relations, Payment Integrity and Government Network teams, to identify & implement initiatives related to provider network contracting, provider payment, and Wellmark’s sustainability goals. This leader will promote teamwork and strong collaborative relationships internally and externally while ensuring we are building and driving comprehensive network strategies across all areas of scope. 

Use your strengths at Wellmark: Our ideal candidate will have strong knowledge of the healthcare landscape and extensive experience with hospital, physician, and other health care organizations payment and contracting strategies, specifically fee-for-service and value-based arrangements, shared savings/shared risk, and financial incentive models, and network performance for commercial and government lines of business. They should be skilled at analyzing, forecasting, and modeling, including interpreting clinical outcomes, claims data, and trends to understand provider network utilization and cost trends, and total cost of care to be able to set internal standards and determine benchmarks. They keep a pulse on the industry and have a keen ability to monitor and lead network intelligence work. 

As a leader of others, they will directly impact the success, growth, and development of team members by setting clear expectations, coaching to each team member’s strengths, and fostering a team-centric work environment. Being a role model in behaviors that demonstrate Wellmark’s Leader Success Expectations and inclusion are essential. 

Our strongest candidates believe health care can be better, and they are passionate about finding ways to influence this important work. They have well-rounded network strategy experience, including knowledge of government programs (such as Medicare Advantage) contracting. They are analytical, innovative, and partner effectively internally and externally using their strong communication skills. From design to implementation and maintenance – they bring structure to ideas. The challenge of working with others to achieve a more advanced shared-savings model is work that excites them. 

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. 

Qualifications

Preferred:

• Master’s degree.
• Business acumen.
• Prior experience leading leaders.

Required:

• Bachelor’s degree or direct and applicable work experience.
• 7+ years of experience in the healthcare industry, with focus on provider contract work that demonstrates a track record of success and expertise with network analytics and network performance as well as with provider network contracting strategies, setup, and regulations, or related industry experience. This includes experience in roles focused on value-based arrangements, relationship management (e.g., physician, hospital), strategic consultation, and analysis of data/information.
• Experience interpreting clinical outcomes, claims data, and trends to understand provider utilization trends and determine benchmarks.
• Formal leadership experience with the proven ability to lead, coach, engage, and develop team members in a dynamic, changing work environment. Track record of success setting team goals, aligning resources effectively, and achieving desired results.
• Analytical with the ability to synthesize data/information into actionable recommendations; thinks critically, creatively and drives continuous improvement focus. Experience analyzing, forecasting, and modeling financial and budget data.
• Advanced analysis, critical thinking, problem solving and research skills with the ability to use data to inform decisions and drive positive outcomes and though a lens of continuous improvement.
• Strong negotiation, influence, and relationship management skills with strong emotional intelligence and business aptitude to understand industry and solve problems.
• Excellent written and verbal communications skills with the ability to share recommendations with varying audiences, including providers. Ability to adapt communication based on audience.
• Strong change leadership skills. Creates a clear view of future state and inspires other to embrace the strategy. Ability to challenge the status quo while maintaining diplomacy.
• Proven ability to thrive in a dynamic environment and drive results through collaboration. Partners effectively with different business areas.
• Ability to travel as needed.

Additional Information

What you will do as a Director of Provider Network Development & Contracting:

a. Provide strategic direction and leadership to network development and contracting, network analytics, network intelligence and network performance teams, including leading all aspects of the provider network development and contracting strategies, the network development plan, network adequacy requirements, collaboration with network analytics, network operations, payment integrity, unit cost management and cost of care initiatives, that align and support Wellmark divisional and department strategy and goals centered around 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 and leader coaching, development, performance improvement, coordination and budgeting for multiple staff, and department specific functions/ services. Cascade and communicate strategy and initiatives to team members, driving customer/stakeholder service, and supporting achievement of overall company results.

c. Provide leadership in evaluating and developing strategic plans that support expansion or change within the network to meet company goals and objectives. Oversee the coordination and negotiation for the network development and contracting department for all commercial and government networks and products.

d. Provide leadership on claim trend data, network performance data, and market information to develop network strategic plans to support contracting initiatives and network cost management. Oversee the management of the budgeting and forecasting initiatives for network cost management, network performance and provider costs and quality. Drive the team to utilize data to inform decisions, evaluate, and partner cross-functionally as needed to resolve complex business and technical problems.

e. Partner closely with key stakeholders and share Wellmark’s provider network development and contracting strategies for commercial and government programs networks as appropriate to ensure a partnership and complete understanding of the business rationale for the decisions, obtaining feedback before finalizing plans, which ensures long term goals and measures are consistent with strategies and objectives for network development and product growth.

f. Develop and drive implementation of large-scale complex provider network strategies for payers across the markets to include network development and expansion planning, network design, network performance optimization, commercial value-based payment models, provider initiatives, and provider data operational efficiencies.

g. Oversee contracting initiatives relating to Blue Distinction Centers, Care Sourcing, and other Blue Cross Blue Shield Association (BCBSA) contracting and lead the team to work with BCBSA and internal stakeholders (legal, network administration, health networks, etc.) to create, distribute, and/or maintain the agreements for these initiatives.

h. Represent both the department as well as Wellmark, regarding issues pertaining to network contracting and payment strategy, including fee for service and commercial value-based payment models, to external audiences including health systems, hospitals, physicians, national health care organizations, BCBSA, and other stakeholders.

i. Serve as a subject matter expert and key thought leader for internal departments when complicated provider issues pertaining to contracts and network status need to be escalated for resolution. Oversees and directs the management and maintenance of provider contract verbiage, including collaboration with Legal.

j. Partner with other key stakeholders to development and drive the implementation of large-scale complex provider network strategies for payers across the markets to include network development and expansion planning, network design, network performance optimization, provider initiatives, and provider data operational efficiencies.

k. Oversee the management and maintenance of provider contract verbiage, including collaboration with Legal.

l. Lead and drive key department/division and interdepartmental/interdivisional projects and encourage effective use of process management tools and programs.

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 at [email protected]

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