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. 

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.  

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