Care provider Jobs in Des moines ia

Job Description

Job Description

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 here.

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

Job Description

Bring your strengths to Wellmark as a Provider Network Contract Manager!

About the Role : As a Provider Network Contract Manager, you will drive initiatives that support the development, innovation and maintenance of Wellmark's Health Care Network Contracting strategy for Commercial and Government programs. You will take the lead on building and maintaining relationships with health care organizations and network providers to aid in successful development and negotiation of contracts. You won’t do it alone though. You will collaborate with internal stakeholders to gather data and insights to aid in this work. You will also provide input for decisions related to the composition of Wellmark’s health care provider networks to develop new provider networks and strategies.

About You : You thrive when you are thinking ‘outside of the box’ and have a creative mind when it comes to negotiating and creating sophisticated and complex health care provider agreements and amendments. You have strong communication skills, both verbally and written, and are able to effectively articulate complex information to a variety of audiences. You are a self-starter with an eye for detail. You have strong analytical skills which help you evaluate large sets of data with the ability to summarize findings in executive summaries. You are skilled in health care organization strategy development and implementing new policies. You are excited about the opportunity to leverage your persuasion skills to influence the changes needed to support business strategies and initiatives, while utilizing your health care organization contract experience to drive impactful results.

Internal Job Title : Network Contract Manager

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

Qualifications

Required Qualifications :

• Bachelor’s degree or direct and applicable work experience.
• 4+ years of managed care, health care provider negotiation or contracting related experience that demonstrates :
• Knowledge of contracting strategies, provider reimbursement methodologies, contract administration, setup, and maintenance.
• Understanding of compliance and adequacy requirements.
• Strong negotiation, influence, and relationship management skills.
• Strong written and verbal communications skills with the ability to share recommendations with varying audiences, including providers. Adapts communication based on audience.
• Strong analytical and critical thinking skills. Thinks creatively and uses data to drive positive outcomes and improvements.
• Proactive self-starter with effective time management and prioritization skills. Successfully manages and tracks projects. Attentive to details and quality.
• Proven ability to thrive in a dynamic environment and drive results through collaboration. Partners effectively with different business areas.
• Proficiency with Microsoft Office, such as Word, PowerPoint or Excel, and other applications. Learns new systems quickly.
• Ability to travel.

Preferred Qualifications :

Additional Information

What you will do as a Provider Network Contract Manager :

a. Work cross-functionally to help develop and execute Wellmark’s and / or BCBSA’s network strategies. Maintain accountability for specific contract initiatives.

b. Analyze data to design and recommend provider contract methodology strategies and provider specific strategies.

c. Analyze data to design and recommend contract amendments. Perform network analysis, strategy development and implementation; obtain data, verify validity, and analyze network availability / access for contracting opportunities.

d. Work collaboratively with contract team and HCI leadership regarding provider contracting requirements and to draft new provider contracts and amendments to existing provider contracts.

e. Build and maintain relationships with providers by communicating regularly with providers regarding contract initiatives and new contract opportunities. Provide responses to inquiries regarding Wellmark’s contracts.

f. Support division wide communications with the coordination of internal messaging of provider contracting initiatives.

g. Create unique agreements / amendments related to payment or special benefits for an employer, i.e., high performance network, tiered networks, carve-out benefits, etc.

h. Assist with any contract research for audit, compliance, and contract management, etc.

i. Complete network adequacy reviews and QHP template annually for all required networks.

j. Assist Legal and / or compliance with Insurance Division provider network inquiries and E&O application.

k. 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 [email protected]

Please inform us if you meet the definition of a "Covered DoD official".