Director Provider Relations

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.

Job Description

As a Director of Provider Relations, you will deliver strong leadership and strategic direction for Wellmark's representation across the provider network to effectively meet the needs of our clients, members, providers, and other stakeholders. You will be accountable for the relationship management between Wellmark and physicians, hospital leaders, clinic administrators, and other healthcare professionals. In addition, you will be responsible for the management of a matrixed team who builds and maintains strong, positive relationships with providers and looks for areas of joint success planning.

In this role, you will oversee a 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. Collaboration is key so you will partner with internal stakeholders by building and maintaining an internal governance model that fosters the relationship with network providers. You will also drive customer value and competitive advantage through a lens of innovation and change for enhanced provider relations which, when coupled with enhanced medical/benefit management techniques, improves health status and provides affordable and accessible healthcare products and services to customers.

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 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.

• This position will work a hybrid schedule: Tuesday through Thursday in Wellmark's Des Moines office, with the option to work remotely Monday and Friday. As a leader, there may be additional days in the office to meet business needs.*
  
  

This job requires a non-compete agreement.

Qualifications

Preferred Qualifications - Great to have:

• Prior experience working in both commercial and government program sectors is preferred.
• Understanding of and experience working with regulators at the state and federal levels (CMS, CMMI etc.) preferred.
• Previous experience within the provider network or health system and the ability to bring forward ideas and drive strategies to support the network; part ner 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.
  
  

Required Qualifications - Must have:

• Bachelor's degree or direct and applicable work experience.
• 7+ years of health insurance, managed care, State or Federal health program, or related industry experience that includes demonstrated relationship management skills with the ability to maintain positive, long-term relationships with hospital, physician, and other healthcare leadership and/or personnel that promote positive and influential provider relations, effective negotiations and marketing capabilities.
• Subject matter expertise in network development, contracting, risk sharing, and the development and implementation of innovative value-based contracting and alternative payment models.
• Demonstrates knowledge concerning how organizations function and can get things done through formal and informal channels and networks.
• Formal people leadership experience, including building/developing high performing teams. Establishes clear goals/expectations, aligns resources, and motivates teams to achieve success in meeting business objectives.
• 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.
• Proven capability to gather, interpret, and provide timely feedback to drive alignment and engagement.
• Ability to develop 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.
• Ability to generate innovative solutions and is skilled at moving from strategy into tactics.
• Strong change leadership skills. Creates a clear view of future state and inspires others to embrace the strategy. Ability to challenge the status quo while maintaining diplomacy; finds common ground and solves problems.
• Proactive, resourceful self-starter with effective prioritization skills and strong attention to detail.
• Proficiency with the Microsoft Office Suite.
• Travel - 15%-20% of the time, including some overnight stays. Valid driver's license required.
  
  

Additional Information

What you will do as a Director of Provider Relations:

• Provide strategic direction and leadership for a team that supports Wellmark and divisional strategy and goals. Cascade and communicate Provider Relations strategy and initiatives to team members, driving customer/stakeholder service, supporting achievement of overall company results.
• Lead a team that provides ongoing monitoring and management of provider relations opportunities and implements strategies to support Wellmark’s relationships with providers as well as provider communication and education efforts. Partners in the influencing for providers to act and produce measurable outcomes relative to improving quality, efficiency of care, and administrative performance.
• Leads and drives team to take in information from multiple sources (product teams, network team, etc.) and synthesize impact to providers, create plans for communications and provider support to augment rollout and when appropriate, raise the flag and work with teams to better align or bifurcate certain initiatives.
• 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 staff, and department(s) specific functions/services.
• Work collaboratively with the VP, Provider Relations & Engagement to 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.
• Develop and maintain collaborative relationships with senior leaders and cross functional business units to consult with and facilitate discussions to ensure that dependencies are captured, and synergies are aligned. Connect and sequence initiatives to ensure key performance measures are met.
• Provide oversight of activities that support positive physician/hospital relationships with a focus on data driven, collaborative approaches. Analyze the underlying drivers ("the why") behind trends and outcomes and clearly articulate those insights to external audiences in a way that builds understanding, trust, and alignment. Ensures collaboration with network providers to identify and execute on mutually beneficial initiatives that produce measurable outcomes on key administrative performance metrics.
• Develop relationships and partner with the VP, Provider Relations & Engagement to represent Wellmark on both a state and national level 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 stakeholders. 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 at [email protected]

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

At this time, Wellmark is not considering applicants for this position that require any type of immigration sponsorship (additional work authorization or permanent work authorization) now or in the future to work in the United States. This includes, but IS NOT LIMITED TO: F1-OPT, F1-CPT, H-1B, TN, L-1, J-1, etc. For additional information around work authorization needs please refer to the following resources:Nonimmigrant Workers and Green Card for Employment-Based Immigrants