Team Leader - Provider Performance (Commercial / Value-Based)

Qualifications :

Required Qualifications - Must have:

• Bachelors degree or direct and applicable work experience.
• 6 years of experience in health insurance health care or related industry experience as well as in roles focused on value-based contract management health care organization value-based performance relationship management (e.g. physician hospital) strategic consultation and analysis of data/information.
• Strong abilities in the interpretation of data (e.g. outcomes trends assessment of benchmark data). Demonstrated problem-solving quantitative and analytical skills with the ability to recognize inconsistencies analyze for reasonableness and accuracy research and come to conclusion in a wide variety of changing analytical situations.
• Ability to build and maintain strategic ongoing relationships with colleagues and external stakeholders e.g. health care organizations physicians physician aggregators hospitals and Accountable Care Organizations.
• Leadership skills typically gained through a combination of project or informal leadership that demonstrates knowledge of work processes products and services and leadership competencies.
• Proven skills in motivating and influencing others; ability to build collaborative relationships across the organization.
• 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.
• Ability to travel 15-20% of the time including overnight stays. Valid drivers license required.

Preferred Qualifications - Great to have:

• Previous sales or account management experience.
• Previous value-based contracting experience.
• Knowledge of contracting and payment strategy medical policy benefit designs and product offerings.

Additional Information :

What you will do as a Team Leader of Provider Performance:

a. Provide leadership and day-to-day management of financial and human resources primarily focusing on employee coaching development performance improvement coordination and budgeting for staff and department(s) specific functions/services. Support business objectives and produce results that are effective accurate and timely and on target to meet HR team and stakeholder needs.

b. In partnership with Network leadership support the development of the  broader network strategy across lines of business.

c. Implement new inputs and processes to create assets that inform decision makers at key points within both strategic decision making and negotiation processes.

d. Work collaboratively with key health care organizations 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.

e. Lead a team of value-based payment consultants that will be responsible for relationship development critical value-based contracting and 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.

f. Individual will lead a team responsible for the execution of new value-based payment models and/or execution of changes to existing value-based payment models with health care organizations.

g. Develop health care organization physician aggregator and other strategic provider relationships by conducting management 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.

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

i. 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.

j. Oversee and drive strategic initiatives for Wellmarks relationships with key health care organizations physician aggregators and other strategic stakeholders; including managing relationship for assigned health care organizations.

k. Ensure staff are versed in best practices and of value-based payment and healthcare trends. Provide direction to ensure objectives and outcomes are met interactions are relevant and engaging for the audience.

l. Oversee and direct positive relationships with key health care organizations with a focus on a collaborative approach to quality care total cost of care and sustainability. Work collaboratively with key heath care organizations to keep them engaged in strategic Wellmark initiatives and produce measurable outcomes relative to improving quality and efficiency of care.

m. Partner with Network Performance and Network Payment Strategy leaders Medicare Advantage Communications and other internal stakeholders to design and create health care organization performance and education materials. Facilitate and deliver presentations to health care organizations and other mediums as necessary. Collaborate and partner with Network Payment Strategy Health Services Medicare Advantage Legal and other internal stakeholders that support the relationships with key health care organizations.

n. 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.

Remote Work :

No

Employment Type :

Full-time