Team Leader - Clinical Quality & Training (Health Services)

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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About the Opportunity: Wellmark is on a mission to make health care better for our members and we are looking for an experienced clinical leader to help us drive this work! As a people-leader, you will coach and mentor the Clinical Quality & Training team through the design and development of Health Services training programs that deliver measurable performance outcomes with a focus on improving member and user experience. 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. You will manage, develop and implement culture, change and engagement programs including, but not limited to, system and performance training, stakeholder engagement, organization design, organizational culture, change management, performance management and talent assessment to achieve the long-term business strategy. You will also ensure standards, documentation and training represent the most up-to-date regulatory and NCQA Accreditation requirements. 

About You: Because this role is a leader of others, this individual will directly impact the success, growth, and development of team members by establishing goals and objectives, setting clear expectations, defining accountabilities, providing regular coaching, facilitating change, and providing an overall positive work environment. Being a role model in behaviors that demonstrate Wellmark’s core competencies is a must. In addition to a passion for developing others, our ideal candidate is skilled at change leadership; effectively managing change will be critical from establishing the business case for change, to operationalizing and communicating evolving business processes both internally and externally. 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.

Preferred Qualifications:

• Knowledge of regulatory standards and regulations - e.g. CMS, State regulations, NCQA, confidentiality
• Experience with training e.g. in health service insurance and/or promotion of Change Management curriculums.

Required Qualifications:

• Minimum of a bachelor’s degree with a clinical license (i.e. Registered Nurse, License Clinical Social Worker)
• 4+ years of management experience in a health care, health insurance, or similar work environment. Experience must reflect two or more of the following: Direct management of a clinical team, management of complex case management; and/or clinical curriculum development.
• 3+ years of experience in the management of utilization management. 
• Leadership skills typically gained through a combination of project or informal leadership that demonstrates knowledge of work processes, services, or leadership competencies.
• Ability to effectively coach/mentor and lead a diverse team through change.
• Demonstrated ability to think strategically and execute operationally/tactically from the big picture to tactics/implementation.
• Strong verbal and written communication skills, including the ability to guide, influence others and negotiate care with members, physicians, care facilities, or similar audiences.
• Proactive, resourceful self-starter. Demonstrates strong understanding of established resources, processes, and guidelines, yet is able to independently make decisions or recommendations under ambiguity.
• Organized, structured approach to change management and continuous process improvement.
• Ability to succeed in and lead others in a dynamic work environment where member experience and engagement production or quality goals are measured. Lead change, inspire others, develop people, etc.

What you will do:

a. Provide day-to-day leadership of financial and human resources, primarily focusing on employee and leader coaching, development, performance improvement, coordination and budgeting for Health Services Clinical Quality Auditing and Training

b. Partner with Health Services leadership and business stakeholders to design, facilitate and manage training and development activities for clinician and non-clinician training, including curriculum design, content, and implementations strategies. Drive, analyze, interpret training KPIs and propose effective action plan for improvement.

c. Lead the development and continuous improvement of a comprehensive training strategy and roadmap ensuring strategic alignment of training and development with business goals.

d. Evaluate the effectiveness of learning and development programs through observation, assessment, and auditing; makes recommendations designed to enhance outcomes, engagement, and learning experience. Conduct ongoing needs assessments with senior leadership to understand and address any gaps in training process and/or products.

e. Implement instructional design and continuous improvement models in all phases of learning and development.

f. Partner with various departments to ensure the marketing and communication strategy for training offerings is executed.

g. Lead the development and continuous improvement of a comprehensive quality assurance program that will define, measure against and coach to achieve performance results in alignment with key quality metrics in collaboration with Health Services leadership. Monitor and incorporate learnings from quality reviews, audits and complaints into future process, standard and training documentation.

h. Generate and ensure accurate reporting of quality measurements for Health Services leadership and stakeholders. Proactively provide comprehensive analysis to identify potential quality issues and recommend applicable solutions.

i. Ensure the successful onboarding and continued development of Health Services staff.

j. Lead future enhancements to and/or maintenance of all documentation stores and communication channels for the department (e.g., Health Services Website, SharePoint, MS Teams).

k. Ensure that regulatory standards, accreditation standards and internal guidelines are adhered to; remain current and consistent with the standards pertinent to Health Services including NCQA Accreditation and Wellmark’s Provider Guide.

l. Collaborate with members of Legal and Compliance to ensure all documentation complies with regulatory standards, accreditation standards and internal guidelines.

m. Other duties as assigned.

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 [email protected]

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