Team Leader - Clinical Quality Management & Accreditation

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 is on a mission to make health care better for our members and we are looking for an experienced clinical quality leader to help us drive this work! As a people-leader, you will coach and mentor the Health Services Quality Management team through the development, implementation and monitoring of key health plan quality, clinical risk management and accreditation programs to support Wellmark’s Total Cost of Care strategy. You will help us build programs that not only meet quality standards but also will be tasked with helping the organization ingrain this work into the day-to-day functions of the business. You will do this through actively partnering with various areas of the organization to help educate and guide them through their role in program success.  

As a leader of others, you 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. In addition, you are skilled in leading through change and setting your team up for success by actively communicating and managing through ambiguity. You are a “people person” and love building organizational relationships and influencing others in a way that positively impacts the lives of our members.

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).

Qualifications

Required Qualifications:

• Bachelor's degree and/or applicable work experience.
• 4+ years of diverse clinical health care related experience. Experience must reflect two or more of the following: managed care, provider support, healthcare or health plan performance improvement, regulatory knowledge or quality improvement initiatives.
• Leadership skills typically gained through a combination of project or informal leadership that demonstrates knowledge of work processes, services, or leadership competencies. Ability to lead a diverse team through change.
• Prior regulatory and accreditation (NCQA, HEDIS) experience in both surveys and CMS and state program audits.
• Ability to use data to identify opportunities for improvement with the ability to make recommendations.
• Commitment to service excellence and member advocacy. Anticipates member and provider needs and takes appropriate actions; thinks critically and creatively yet understands resources and guidelines.
• Operates with agility, flexibility, and resourcefulness; effectively manages and adapts to change.
• Ability to organize multiple priorities and succeed in a dynamic work environment where quality goals are measured. Committed to timeliness, follow up, accuracy and detail.
• Strong verbal communication skills. Influences action and facilitates crucial conversations on care with members, physicians, and care facilities. Excellent crisis-counseling and problem-solving skills.
• Strong written communication skills, including accurate documentation of events within electronic documentation system; ensures quality and consistency by following set guidelines and processes. Demonstrated abilities in writing program descriptions, evaluations, procedures, and state/federal documents. (moved from job responsibilities).
• Develops collaborative relationships and maintains professionalism with peers, stakeholders, and members.
• Strong technical acumen; learns new technology and systems quickly - e.g., Microsoft Office Suite, electronic charting, documentation systems.

Preferred Qualifications:

• Prior regulatory and accreditation experience in both surveys and audits in a formal or informal leadership capacity.
• Managed Care experience.
• Clinical licensure. Active and unrestricted clinical l