Director - Government Network Strategy & Performance

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 .

Want to know more? You can learn about life at Wellmark .

Job Description

About the opportunity : Wellmark’s Director of Government Network Strategy & Performance will provide leadership and strategic direction for Wellmark's government programs network performance strategy, value-based payment and provider incentive programs requiring coordination across the enterprise and with joint venture (JV) partners.

This Director will be accountable for the oversight and coordination of health network initiatives and strategies focused on developing and executing on government products strategy, Medicare Advantage Stars quality measures, risk adjustment accuracy and overall provider network performance strategy.

In addition, this critical role will serve as lead facilitator in program development to ensure effective implementation, compliance, and contractual arrangements to fulfill regulatory requirements, communication, and monitoring of designated programs.

This people-leader will be responsible for management of the Government and Medicare Advantage health networks team who builds and maintains collaborative provider relationships to achieve network performance results and goals in support of the value-based payment model and financial incentives strategies.

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 : 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 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), STARS measures and risk adjustment, and value-based care.

They are analytical, innovative, and partner effectively internally and externally using their strong communication skills to influence and drive strategic work forward.

From design to implementation and maintenance - they bring structure to ideas.

This position will work a hybrid schedule of at least 3 days in Wellmark's Des Moines office, with 2 days remote option.

As a leader, there may be additional days in the office to meet business needs.

Qualifications

Preferred Qualifications :

• Master's degree.
• 2+ years' experience with Medicare, Medicare STARS ratings, quality, coding and risk adjusted revenue.
• Experience with provider quality, outcomes and risk adjustment initiatives strongly preferred.
• Experience with member experience initiatives strongly preferred.
• CPHQ certification (Certified Professional in Health Care Quality).

Required Qualifications :

• Bachelor's degree or direct and applicable work experience.
• 7+ years of health insurance or related industry experience that reflects progressive experience in government programs such as Medicare, DSNP or Medicaid.
• Demonstrates knowledge of applicable Medicare rules / regulations, STARS measures, incentive strategies, risk adjustment and / or related quality standards, measures, or reporting requirements (, NCQA, HEDIS, CMS, CAHPS).
• An ability to instruct, explain and improve leading indicators of success in Medicare Advantage programs.
• Track record of success leading complex programs / projects. Demonstrates effective understanding of interdependencies, strategic planning, financial acumen, decision making, and resource management.
• Strong consulting skills. Develops collaborative relationships with executives, stakeholders, operational teams, and vendor partners.

Builds trust, understands needs, influences decisions, negotiates, and resolves conflict to achieve results.

• Forward-thinking and skilled at moving from strategy into tactics and execution; effective at bringing structure to vision.
• Analytical with the ability to synthesize data / information into actionable recommendations; thinks critically, creatively and drives continuous improvement focused.
• Formal people leadership experience, including building / developing high performing teams. Establishes clear goals / expectations and motivates teams to achieve success.
• Exceptionally strong communicator with executive presence. Effectively delivers a variety of messages to diverse audiences, including external stakeholders.
• 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.

Additional Information

What you will do as a Director of Government Network Strategy & Performance :

a. Provide the strategic direction and leadership for a team that supports Wellmark and divisional strategy and goals. Cascade and communicate Government and Medicare Advantage strategy and initiatives to team members, driving customer / stakeholder service, supporting achievement of overall company results.

b. Lead a team of Government and Medicare Advantage Network Performance Managers and Consultants that provide ongoing monitoring and management of provider performance opportunities for coding accuracy, quality benchmarks and total cost of care related to provider incentives and value-based payment initiatives and ensure strategic focus is on target with overall company strategy.

c. 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.

d. Work collaboratively with the VP, Health Networks and Government Programs and Joint Venture partners in the identification, planning, execution and management of quality assessment, cost of care and performance improvement strategies and initiatives including Medicare Advantage provider interventions, strategies and operational tactics that support the achievement of accurate risk adjustment, quality and Star ratings across the Medicare Advantage business.

e. Develop and maintain collaborative relationships with senior leaders, JV partners and cross functional business units to consult with and facilitate discussions to ensure that dependencies are captured, and synergies are aligned to effectively help leaders understand the implications on the plan and overall performance.

Connect and sequence initiatives to ensure key performance measures are met.

f. Direct Wellmark's Government and Medicare Advantage provider incentives and value-based payment strategy development, planning, implementation, and monitoring.

Oversee interdisciplinary responses to contractual expectations including representation from Health Networks, Medicare Advantage, Legal, Analytics, Health Services, Technology, Compliance, and other business areas as needed.

g. Negotiate competitive and complex, Government and Medicare Advantage provider incentives and value-based contractual relationships with health care organizations, physicians, and strategic stakeholders according to Wellmark guidelines and quality and financial standards.

h. Lead change management to ensure successful provider practice transformation and innovation under Government and Medicare Advantage provider incentive and value-based payment contracts.

i. Facilitate and maintain relationships between Wellmark and vendors that support Wellmark’s Government and Medicare Advantage provider incentive and value-based payment programs, including vendor evaluation, relationship management, performance management and ensuring contract standards and obligations are fulfilled.

Lead monthly and / or quarterly business review meetings with vendors and executive management as appropriate. Identify emerging vendor capabilities that may enhance or optimize our provider payment and contracting strategy.

j. Provide training, ongoing mentoring, and consultation to department members, providers, and internal staff on company’s applicable policies and procedures.

k. Act as the subject matter expert regarding Government products, Medicare Advantage, risk adjustment, quality and Medicare Stars program to ensure objectives are implemented and improvement initiatives and strategies are met to support the overall strategic goals.

l. Coordinate with internal / external resources to ensure successful results in medical record retrieval projects, prospective coding programs, provider education initiatives and dissemination of coding best practices aimed at improving quality measures and associated health outcomes in a cost-effective manner.

m. Ensure communication of program execution by providing updates to VP, Health Networks and Government Programs, JV partners and leaders to drive status transparency and course correction if needed.

n. Analyze data (clinical, satisfaction, health outcomes, utilization, & other as indicated) to evaluate performance, identify and prioritize provider outreach strategies for Stars projects, coding education and risk adjustment initiatives, with the goal to maximize member and provider experience, quality, and Stars outcomes;

determine and communicate / escalate organizational risk or impact of performance gaps or noncompliance.

o. Review and present results of quality and risk adjustment interventions for clinical and operational performance improvements and identify organizational risks to VP, Health Networks and Government Programs, JV partners and leaders.

p. Understand overall organizational processes, operations and challenges that may impact risk adjustment accuracy, Star ratings, quality, and provide insights to JV partners and leaders.

q. Support the continuous improvement of applicable processes through active participation in strategies to enhance organizational structure and processes.

r. Participates in system-focused analysis in response to error identification. Provides input and feedback into the potential impacts (positive or negative) along with the mitigation efforts.

s. Other duties as assigned.

This job requires a non-compete agreement.