Wellmark - Des Moines Director Network Administration in Des Moines, Iowa
Use your strengths as Director of Network Administration
Wellmark’s Director Network Administration will lead the department in developing and maintaining high quality provider networks to support Wellmark’s Health Network and Product strategies. This includes actively managing network participation by denying or removing providers that cannot meet the standards or criteria set by Wellmark. This individual will direct multiple operational teams; manage and integrate large scope projects; complete in-depth research; develop recommendations that impact corporate products and policies; and report network information and data through snapshot summaries that can be used by internal stakeholders. This individual will also influence corporate decision making and actions in connection with the high level goals expressed in Wellmark’s vision, mission, values, and purpose. Maintaining strong business relationships with the provider network and internal areas of Wellmark is essential.
As a leader of others, you will directly impact the success, growth, and development of team members by setting clear expectations, coaching to each team member’s strengths, and fostering a team-centric work environment. Being a role model in behaviors that demonstrate Wellmark’s Leader Success Expectations and inclusion are essential.
Ideal candidates are skilled strategists with passion for ensuring complex operational processes run smoothly. They use data/dashboards to track work activities and inform decisions, and they are effective in partnering with leaders to improve production when necessary. Developing process improvement strategies geared toward making interactions paperless with providers and automation of processes? Ideal candidates would find this type of work energizing, because they love to creatively solve problems and drive continuous improvement.
Bachelor's Degree or direct and applicable work experience.
7+ years of health insurance, managed care, State or Federal health program, or related industry experience that includes:
Track record of success leading and maintaining complex operational programs. Effective strategic planning, resource management, budgeting, forecasting etc.
Demonstrates strong compliance, regulatory and/or legal process knowledge, including contracting.
Knowledge of health care licensing and plan accreditation standards for credentialing is a plus.
Demonstrated leadership experience, including building and developing high performing teams.
Strong analytical, critical thinking, problem solving and research skills; uses data to inform decisions. Creative approach to continuous improvement and optimization.
Strong consulting skills. Balances expertise and business acumen with understanding of customer/stakeholder needs.
Develops collaborative relationships with executives, divisional leadership and operational teams resulting in the consistent development and delivery of strategic business planning solutions. Effectively influences others and resolves conflict.
Exceptional written and verbal communication skills. Effectively articulates business implications and actionable recommendations to varying audiences, including executives. Strong presentation skills.
Skilled at moving from strategy into tactics. Establishes clear goals/expectations, aligns resources, and motivates teams in order to achieve success.
Proactive and adaptable with strong change management skills. Effectively coaches and leads teams through change.
Strong organizational skills, attentive to details, and focused on quality.
Ability to travel <5%.
Prior experience leading leaders
a. Develop and implement an operational model in Network Administration, focusing on provider enrollment, credentialing, contracting, and service, that aligns with the corporate and divisional strategies and objectives. Oversee long term goals and measures that are consistent with these strategies and objectives.
b. Implement strategies to support Wellmark's goal of process improvement with a drive toward automation of activities while reducing administrative expenditures through provider self-service, paperless interactions, and e-credentialing initiatives. Oversee the development of technology, policies, and educational campaigns to support these efforts and perform ongoing assessments of their success.
c. Provide strategic direction and leadership for a team that supports Wellmark and divisional strategy and goals. Cascade and communicate strategy and initiatives to team members, driving customer /stakeholder service and supporting achievement of overall company results.
d. Provide day-to-day leadership of financial and human resources, primarily focusing on employee and leader coaching, development, performance improvement, coordination and budgeting for multiple staff, and departments specific functions/services.
e. Provide oversight of activities that support Wellmark's broad-based health networks in Iowa and South Dakota in order to meet customer expectations for access and quality. Maintain national accreditation statuses, as well as state-of-the-art credentialing and contracting programs that meet or exceed industry standards. Uses data and analytics to support required reporting, tracking, productivity, and measurement of network adequacy.
f. Develop relationships and represent Wellmark with provider licensing boards and accreditation organizations on both a state and national level in order to influence policy development and information sharing. Ensure activities conducted within the Network Administration Department are in compliance with NCQA guidelines, the Public Exchange or other accrediting standards, compliance, department policy, and/or state and federal law.
g. Represent Wellmark with selected health care leaders and/or organizations during the negotiation of new contracts and/or the introduction of new products and provider networks. Work with selected Wellmark customers to develop, recruit, and implement customized health networks on both a local and regional basis.
h. Apply strong analytical, strategic thinking, and problem solving skills in the design and rollout of new Wellmark initiatives, including, assisting with organizational efforts to enhance self-service opportunities for providers via the provider portal.
i. Develop and maintain positive relationships with providers, provider associations, and provider organizations in order to gain cooperation and support for Wellmark's network policies and processes.
j. Develop, maintain, and enhance databases and mainframe systems in order to facilitate the collection, analysis, and reporting of provider data.
k. Provide oversight in the creation of a provider directory by ensuring updates are made, requirements are met.
l. Develop and maintain provider contract prototypes, both current and historical, that articulate Wellmark's and providers responsibilities regarding the provision of and reimbursement for covered services to Wellmark customer.
m. Other duties as assigned.
Requisition ID: 214303
REQUIRES NON-COMPETE?: Yes
External Company Name: Wellmark Blue Cross and Blue Shield
External Company URL: www.wellmark.com