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Provider Network Performance Manager (Value-Based Models/Bundles)

Location
Des Moines, Iowa
Remote Working
Remote Working
Job Type
Permanent
Posted
4 Aug 2022
Company Description

Job Description

The opportunity: Wellmark is doubling down on driving strategic, value-based performance in partnership with health care organizations and you're going to want to be a part of it! As a Provider Network Performance Manager, you will develop and maintain strong, positive relationships with key health care organizations, physicians, physician aggregators, and other key stakeholders. You will leverage these consultative relationships to inform, develop and drive collaborative action plans and value-based performance outcomes, supporting the evolution of a quality, efficiency and total cost of care focused value-based network payment model. With this as a foundation, you will be responsible for facilitating, supporting, and coordinating strategic initiatives with key health care organizations in support of Wellmark's Sustainable Healthcare Goal, driving improved quality and efficiency of care. You'll be inquisitive, data will inform your decisions and a deep intellectual curiosity will drive you to regularly ask questions that further our understanding of what drives performance, where gaps exist and how to best fill them. This analysis will be a primary input into the design, negotiation and deployment of value-based contracts and action plans that drive enhanced provider performance. You will serve as a resource to, and partner closely with, a multi-disciplinary internal team of subject matter experts, including our network innovation analytics team, that support the work of key external health care organizations across multiple lines of business.

Use your strengths as a Provider Network Performance Manager at Wellmark: Our ideal candidate will have strong knowledge of the healthcare landscape in our markets of Iowa and South Dakota, including previous experience developing and/or managing value-based models/contracts and will be equipped with excellent communication skills including an ability to effectively communicate complex information in a compelling manner; you'll be as comfortable delivering a formal executive presentation as you are drafting a detailed proposal and you quickly adjust to a variety of audiences. An analytic mindset is a must - for you solving a complex problem means getting innovative and creative, asking all the right questions and effectively digging into the data along the way. You have a knack for managing health care organization relationships, multiple priorities and others consider you as impossibly organized as you are adaptable. Top candidates will have strong experience in value-based models, particularly bundles. If this sounds like you and you're ready to be a part of making health care better, apply today!

Qualifications

Required:
  • Bachelor's degree or direct and applicable work experience.
  • 4+ years of experience in health insurance, health care, or related industry experience as well as in value-based contract management, network performance and contracting. Experience also in roles focused on relationship management (e.g. physician, hospital), strategy, consultation, and analysis of data/information.
  • Ability to build and maintain relationships with colleagues and external stakeholders.
  • 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.
  • Travel required between 30-40%. Valid driver's license.

Additional Information

a. Work collaboratively with key health care organizations, physicians, physician aggregators and other strategic stakeholders to develop and achieve action plans, quality performance benchmarks, and total cost of care objectives to enhance health care organization performance. 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.

b. Accountable for key health care organization, physicians, physician aggregators and other key health care organizations network performance management by conducting management committees 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 in terms of utilization, patient access, cost of care, compliance with contractual quality measures, etc.

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

d. Individual will be responsible for the execution and/or implementation of new value-based models and/or execution/implementation of changes to existing value-based models with health care organizations.

e. 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.

f. Serve as liaison to health care organizations regarding value-based contract issues and ensure consistency with network payment strategy.

g. Demonstrate knowledge and support of corporate initiatives related to health care organizations engagement, quality and efficiency of care, and prioritize work activities to support them.

h. Other duties as assigned.

This job requires a non-compete agreement.

Hybrid Work Environment: You will have the flexibility to work where you are most productive. As a hybrid employee, you'll spend at least a day a week in the office - leaders and employees will work together on which day(s) they would like to work in the office and which days they prefer to work remotely. This may vary week-to-week based on meeting schedules and other business needs to optimize in-person collaboration.

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
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Details

  • Job Reference: 677710172-2
  • Date Posted: 4 August 2022
  • Recruiter: Wellmark, Inc.
  • Location: Des Moines, Iowa
  • Remote Working: Some remote working possible
  • Salary: On Application
  • Sector: I.T. & Communications
  • Job Type: Permanent