Provider Performance Manager (Commercial / Value-Based)

Wellmark-Blue-Cross-and-Blue-Shiel; Des Moines (IA); Hybrid; USD 90,000 - 130,000; Full time

Job summary

Wellmark Blue Cross Blue Shield is seeking a Network Performance Manager to develop and maintain strong relationships with health care organizations, physicians, and stakeholders. The role focuses on driving action plans, quality performance benchmarks, and total cost of care outcomes within value-based programs.

The successful candidate will balance analytical rigor with relationship management, delivering presentations to executives and adapting to diverse audiences while thriving in a

Qualifications

• Bachelor's degree or equivalent experience in healthcare or related field.
• 4+ years in healthcare with health quality data analysis and network management or provider relations.
• Ability to build relationships with internal and external stakeholders.
• Strong consultation, persuasion, and influencing skills.
• Excellent verbal and written communication with executives and stakeholders.
• Analytical, problem solving, and strategic thinking; willing to innovate.
• Self-starter, able to work independently and on teams.
• Strong organization and prioritization; manage multiple projects.
• Documentation of processes and procedures; decision-making following guidelines.
• Proficiency with Microsoft Office (Word, Excel, Outlook, PowerPoint, Access).
• Travel up to 10%; valid driver's license.

Responsibilities

• Develop and maintain relationships with key health care organizations, physicians, physician aggregators, and other stakeholders to drive action plans and value-based outcomes.
• Monitor and manage provider performance opportunities for total cost of care and quality benchmarks related to value-based initiatives.
• Conduct management committees and joint operating committee meetings and present as needed to review value-based contract compliance and performance.
• Negotiate value-based contractual relationships with health care organizations and stakeholders per Wellmark guidelines.
• Execute and implement new value-based models or changes to existing models with health care organizations.
• Assess external environment for value-based contracting and network performance implications; prepare information for decision-making.
• Serve as liaison to health care organizations regarding value-based contract issues and ensure alignment with network strategy.
• Support corporate initiatives related to engagement, quality, and efficiency of care; prioritize ongoing work.
• Other duties as assigned.

Skills

Relationship management

Healthcare data analysis

Verbal & written communication

Presentation skills

Project management

Analytical thinking

Negotiation

Time management

Microsoft Office

Education

Bachelor's degree or equivalent experience

Tools

Microsoft Office

Job description

Provider Performance Manager (Commercial / Value-Based)

• Full-time
• Department: Clinical | Health Networks | Provider Support
• Pay Grade: 23

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.

Learn more about our unique benefit offeringshere .

Internal Job Title: Network Performance Manager

About the Role:As a Network Performance Manager, you will develop and maintain strong, positive relationships with key health care organizations, physicians, physician aggregators, and other key stakeholders. You will leverage these consultative relationships to inform, develop and drive collaborative action plans and value-based performance outcomes, supporting the evolution of a quality, efficiency and total cost of care focused value-based network payment model. With this as a foundation, you will be responsible for facilitating, supporting, and coordinating strategic initiatives with key health care organizations in support of driving improved quality and efficiency of care. You will be an advocate for commercial value-based programs, both internally and externally.

About you:Using your strong healthcare knowledge and passion for making health care better, you are at your best when you can balance your analytical side with your relational side. You have strong verbal and written communication skills, including a keen ability to effectively communicate complex information in a compelling manner. You are comfortable delivering a formal presentation to healthcare executives and internal stakeholders, with the ability to adjust to various audiences quickly. You are detailed and thorough. For you solving a complex problem means being innovative and creative, asking all the right questions and effectively digging into the data along the way. You have a knack for managing health care organization relationships and multiple priorities. You enjoy working in an environment that isn't always defined or straightforward - working 'in the gray' is exciting to you. From time-to-time there may be difficult conversations and scenarios to work through, but the variety and challenge drives you to succeed as you have a hunger to learn and grow in your career!

This position will work a hybrid schedule of at least 3 days (Tuesday, Wednesday, Thursday) in Wellmark's Des Moines office, with 2 days (Monday, Friday) remote option.

Preferred Qualifications - Great to have:

• Experience in value-based contract management, network performance and contracting. Experience also in roles focused on relationship management (e.g. physician, hospital), strategy, consultation, and analysis of data/information.

Required Qualifications - Must have:

• Bachelor's degree or direct and applicable work experience.
• 4+ years of related healthcare industry experience that reflects analysis of health care quality data and network management or provider relations.
• Ability to build and maintain relationships with colleagues and external stakeholders.
• 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.
• Travel required up to 10%. Valid driver's license.

What you will do as a Network Performance Manager:

a. Work collaboratively with key healthcare organizations, physicians, 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. 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.
b. Accountable for key health care organization, physicians, physician aggregators and other key healthcare organizations network performance management by conducting management committees 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.
c. Negotiate competitive and complex, value-based contractual relationships with health care organizations, physicians, physician aggregators, and strategic stakeholders according to Wellmark guidelines and quality and financial standards.
d. Individual will be responsible for the execution and/or implementation of new value-based models and/or execution/implementation of changes to existing value-based models with health care organizations.
e. 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.
f. Serve as liaison to health care organizations regarding value-based contract issues and ensure consistency with network payment strategy.
g. Demonstrate knowledge and support of corporate initiatives related to health care organizations engagement, quality and efficiency of care, and prioritize work activities to support them.
h. 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 [emailprotected]

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.