Provider Performance Consultant - Medicare Advantage

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!

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Use your strengths as a Provider Performance Consultant – Medicare Advantage at Wellmark:

About the role: As a skilled consultant supporting Medicare Advantage provider performance, you will develop and maintain strong, positive relationships with Wellmark’s provider network to optimize performance of our Medicare Advantage Stars, quality and clinical risk programs. To do this, you will analyze program data to identify areas for improvement and collaborate and consult with providers to improve value-based payment, quality and risk measures.

About you: Our ideal candidate will have health insurance, health care or pharmaceutical industry experience. A business analytics mindset is a plus! For you, problem solving means being innovative, identifying trends, and anticipating obstacles. You are a skilled communicator, both verbally and in writing, and have a knack for building and maintaining strong relationships with providers and have a keen ability to influence decisions. You are skilled in creating and communicating insights from data to help ‘tell the story’ to stakeholders. Change and ‘the unknown’ doesn’t scare you – it's a chance to build out a new program and learn within a growing Wellmark team. Value-based care experience a plus!

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

Internal Job Title: Network Performance Consultant – MA

Required:

• Bachelor's degree or direct and applicable work experience.
• 3+ years of related healthcare industry experience that reflects analysis of health care data and network management or provider relations.
• Experience working with health care organizations and physicians. Experience also in roles focused on relationship management (e.g., physician, hospital), strategic consultation, and analysis of data/information.
• Ability to build and maintain relationships with colleagues and external stakeholders.
• 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.
• Strong analytical skills, data management capabilities, problem solving and critical thinking. Ability to review data and provide measurable outcomes and trend measures to support and influence business decisions.
• Technical aptitude to learn new data management and analysis tools or methodologies quickly.
• 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.
• Collaborative approach to work with and ability to partner with different business areas.
• Ability to develop and maintain documentation of processes and procedures and make decisions by following established guidelines.
• Proficiency with the Microsoft Office Suite.

Preferred:

• Knowledge of CMS Star Rating measures, clinical standards of care, preventive health, and risk adjustment.
• Knowledge of CMS rules and requirements of Medicare Advantage health plans.
• Knowledge of value based care landscape.

a. Work collaboratively with the Medicare Stars & Risk Adjustment team to support the development of Medicare Advantage network strategies that support Star Ratings and risk adjustment.

b. Partner with internal stakeholders and/or external vendors in the definition, design, implementation, and maintenance of data files and data extracts to meet quality reporting needs of Wellmark’s Medicare Stars and clinical risk initiatives.

c. Support the Medicare Stars & Risk Adjustment team with the development of comprehensive, provider-specific action plans to increase Stars and quality performance, facilitate clinical documentation improvement and improve practice outcomes.

d. Develop dashboards and executive summaries to monitor and track key health care organization performance on value-based contracts and payment initiatives.

e. Development and preparation of materials for conducting management committees and clinical and financial performance committee meetings, routine meetings, strategic initiatives, and presentations with healthcare organizations.

f. Assist the Medicare Stars & Risk Adjustment team with the negotiation of value-based contractual relationships with health care organizations.

g. Collaborate with the Medicare Stars & Risk Adjustment team and joint venture partners to support the implementation of new value-based models and/or implementation of changes to existing value-based models with health care organizations.

h. Coordinate communication between health care organizations and leadership to effectively disseminate information related to contract review, performance, goals, and opportunities.

i. Develop external communications and presentations for key health care organizations.

j. Apply project management skills to execute, monitor, and drive activities planned or in progress to ensure coordination of resources and completion of milestones.

k. Perform market research and health care intelligence activity to continually assess external environment and emergence of value based contracting and network performance activities and implications for Wellmark, including analyzing and preparing information for leadership.

l. 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 careers@wellmark.com