Payment Integrity Program Manager Jobs in Iowa (NOW HIRING)

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

About the opportunity:  Wellmark's Director of Provider Network Contracting will provide leadership and strategic direction for Wellmark's highest level of provider network contracting initiatives and negotiations with overall accountability and leadership of program prioritization, strategic planning, and execution of complex provider agreements. They will partner crossfunctionally with Network Contracting, Network Payment Strategy, Provider Relations, Payment Integrity, Legal, Operations, and other business areas to design and implement contracting and provider payment strategies that support network cost of care, quality and outcomes performance and longterm sustainability. In addition, they will oversee sophisticated provider network initiatives that mitigate risk, improve quality and affordability for members, and ensure adherence to contract performance and enterprise outcomes. They will also promote teamwork and strong collaborative relationships in a highly matrixed environment, facilitating the successful cohesion of all department functions and across the organization.

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. Top candidates will have large-scale, high-impact experience negotiating provider network contracts.

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 and contracting experience. 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 (Tues-Thurs) in Wellmark's Des Moines office with 2 days remote option (Mon/Fri). As a Director, you may be in-office on Mondays and Fridays periodically to meet business needs.

Qualifications

Preferred Qualifications - Great to have:

• Master's degree.
• Business and industry acumen.
• Prior experience leading people-leaders.
• Experience leading high-impact provider network negotiations.

Required Qualifications - Must have:

• 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 provider network contracting strategies, setup, and regulations, or related industry experience. This includes experience in roles focused on commercial, value-based arrangements, relationship management (e.g., physician, hospital), strategic consultation, and analysis of data/information. Additional experience in network analytics and network performance preferred.
• Strong negotiation, influence, and relationship management skills with strong emotional intelligence and business aptitude to understand industry and solve problems.
• Experience interpreting network analytics, quality and clinical outcomes, claims data, and trends to understand provider utilization trends and determine benchmarks.
• Proven track record delivering and demonstrating superior negotiating, communication, and critical thinking skills. Strong understanding of principles and practices of contract negotiation and administration, including an in-depth understanding of complex contract provisions.
• Formal leadership experience with the proven ability to lead, coach, engage, and develop team members in a dynamic, changing and matrixed 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.
• Excellent written and verbal communications skills with the ability to share recommendations with varying audiences, including executives and providers. Ability to adapt communication based on audience.
• 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.
• 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:

a. Lead and direct complex provider network contract negotiations, serving as the primary strategist and decision-maker for high-value, complex provider agreements. Develop negotiation strategies that balance affordability, quality, risk mitigation, and network sustainability while aligning stakeholder interests, achieving enterprise objectives, and ensuring favorable contractual and financial outcomes for Wellmark.
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. Partner with all areas of the Network team for all commercial and government networks and products.
d. Leverages the analysis and interpretation of claim trends, network performance metrics, and market intelligence to inform contracting strategies, support network cost management, and influence datadriven decision making; partners crossfunctionally to resolve complex business, financial, and technical challenges.
e. Partner closely with key stakeholders and share Wellmark's provider network 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. 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.
h. 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.
i. 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.
j. Lead and drive key department/division and interdepartmental/interdivisional projects and encourage effective use of process management tools and programs.
k. 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 

Wellmark supports and expects the responsible use of AI for our workforce! We welcome the responsible use of these tools by job seekers as well and are interested in learning from you; you will have an opportunity in the application process to share which tools you used and how you applied them.