12 days old

Director Health Services - Performance

Wellmark
Des Moines, IA 50309

Job Summary<\/h2>

Help us lead change and transform the member experience<\/strong><\/p>

The health care industry is changing, and Wellmark is working to help change it for the better. We recognize that our members deserve health care with a focus on quality. We also recognize that health care is complex. Were embarking on a journey to help our members navigate and use the system in order to help them make clear, informed decisions, and were also ensuring that we take a team-centric approach when working with and in support of our members. The work that our diverse business and care teams are doing in collaboration with our health care partners will create these changes, all while working to minimize health care costs.<\/p>

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Use your strengths as Director Health Services \u2013 Performance<\/strong><\/p>

In this new leadership role, you will set strategic and tactical performance measures, vision, and drive synergy for Health Services initiatives. Focused on driving optimal member engagement and experience, you lead leaders and manage teams comprised of performance reporting and optimization, quality and accreditation, and medical/pharmacy policy development. You design and execute evidence-based measures and controls, mature health service reporting policies and standards, and ensure alignment with the goals, objectives and strategic plans for the department and company \u2013 all while continually seeking opportunities to be results oriented and add value and differentiate Health Services from other payors.<\/p>

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Because this role is a leader of others, you directly impact the success, growth, and development of team members by setting clear expectations, defining accountabilities, coaching to each team members unique strengths, facilitating change, and providing an overall positive and team-centric work environment. Being a role model in behaviors that demonstrate Wellmarks core competencies and strengths-focus is a must. Aside from passion for leading leaders and teams of analyst and quality experts, ideal candidates are creative problem solvers who are skilled at leading complex initiatives with diverse teams through change. Theyre effective at creating the structure, measures, and controls to measure outcomes that help us demonstrate value and achieve excellence.<\/p>

Qualifications<\/h2>

Minimum Qualifications: <\/u><\/strong><\/p>

  • Bachelors Degree in STEM or other quantitative degree program (e.g., health informatics, economics, analytics, epidemiology, etc.)<\/em> OR direct and applicable work experience.<\/li>
  • 7+ years of in-depth health care system knowledge and progressive experience that reflects:
    • An emphasis on health outcomes, population health and care management programs in various settings \u2013 e.g., health plans, community partnerships, etc. <\/li>
    • Exposure to health care data/systems. Advanced ability to analyze large, complex data sets; strategically uses data to inform decisions and drive outcomes.<\/li>
    • Implementation and tracking of clinical, care and utilization management, or health improvement program performance. <\/li> <\/ul><\/li>
    • Demonstrated leadership experience, including building and developing high performing teams.<\/li>
    • Strong consulting skills. Balances expertise and business acumen with understanding of customer/stakeholder needs.<\/li>
    • Excellent analysis, research and critical thinking skills. Effective at synthesizing data into actionable insights and telling the story through data.<\/li>
    • Strong technical acumen; learns new data systems/tools/methodologies quickly.<\/li>
    • Knowledge of applicable policies, regulations, guidelines or standards (e.g. NCQA, URAC, HEDIS, QRS/QIS)<\/em> and potential implications to the department. Evaluates risks and takes appropriate actions.<\/li>
    • Creative problem solver with a continuous improvement, quality focused approach. <\/li>
    • 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 to break down barriers and resolve conflict.<\/li>
    • Exceptional written and verbal communication skills. Effectively articulates business implications and actionable recommendations to varying audiences, including executives. Strong presentation skills.<\/li>
    • Thoughtful approach to work prioritization and management. Skilled at moving from strategy into tactics and process. Establishes clear goals/expectations, aligns appropriate resources, and motivates teams in order to achieve success.<\/li>
    • Proactive and adaptable with strong change management skills. Effectively coaches and leads teams through change.<\/li>
    • General understanding of medical policy development and/or formulary management.<\/li>
    • Attentive to details, quality, and effective at establishing governance.<\/li>
    • Ability to travel <5%.<\/li><\/ul>

      Preferred Qualifications: <\/u><\/strong><\/p>

      • Master's Degree or PhD; analytics, epidemiology, statistics, quantitative social sciences, or a related area a plus.<\/li>
      • Federal and state regulatory knowledge.<\/li>
      • Prior experience leading leaders.<\/li><\/ul>

        JOB ACCOUNTABILITIES<\/h2>

        a. Set the vision for clinical quality, optimization and performance for Health Services by providing strategic direction and leadership for multiple teams that support Wellmark, divisional, and department strategy, goals and outcomes with the ultimate focus on member experience/engagement. Cascade and communicate strategy, tactics and initiatives to team leaders and members, driving customer/stakeholder service, and supporting achievement of overall company results.<\/p>

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        b. Provide day-to-day leadership<\/strong> of financial and human resources, primarily focusing on employee and leader coaching, development, performance improvement, coordination and budgeting for multiple staff, and teams specific capabilities and functions/service.<\/p>

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        c.Drive the analysis, design<\/strong>, development, implementation and evaluation of innovative and effective learning and development solutions that build team capabilities, enhance employee engagement, and improve team and individual performance.<\/p>

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        d. Performance Measures, Optimization and Reporting<\/strong> \u2013 Lead and oversee member identification, stratification and segmentation. Partner with business stakeholders to develop and continuously improve identification and stratification models. Identify key performance indicators, outcome measures and methodologies to measure, monitor and report on results. Interpret and analyze data from various sources and recommends best approaches for its consolidation and use to support quality of care and best member healthcare outcomes. <\/p>

         <\/p>

        e. Lead the design and development of tools/mechanisms to determine and document the outcomes and value associated with care and utilization management interventions and activities.<\/p>

         <\/p>

        f. Lead and facilitate medical policy and formulary decision making processes, ensuring related policies are optimally managed. Reference data to inform decisions, including member/customer relevant health outcome research and analysis.<\/p>

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        g. Develop strategy and identify opportunities to improve stratification and targeting through assessment of existing programs, interviews with internal stakeholders and external benchmarking. Provide thought leadership around the application of new data sources and metrics for improved risk stratification and impactable opportunity identification and activation.<\/p>

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        h. Implement best in class problem solving, analysis and reporting (Control, Monitoring and Outcome). Lead a team responsible for analyzing data, predict and measure outcomes and make recommendations to leadership. Design and distribute business and executive dashboards and reporting visualizations regularly. <\/p>

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        i. Medical & Pharmacy Policy and Formulary Management<\/strong> \u2013 Oversee research, development, implementation (hand-off to operations) and maintenance for medical policies and pharmacy formulary. Ensure medical and pharmacy policies are evidenced based and supported by appropriate literature, studies and trials. Oversee the management and coordination of the medical and pharmacy policy committees as applicable. <\/p>

         <\/p>

        j. Quality, Accreditation & Compliance<\/strong> \u2013 Oversee the coordination of Wellmarks enterprise accreditation through the National Committee for Quality Assurance (NCQA) and certification by the Kansas Utilization Management program. Continually foster and manage the relationships with internal stakeholders instrumental in achieving accreditation and implementing quality improvement initiatives. Coordinate and support activities of Wellmarks Quality Committee and the Population Health Management strategy while ensuring compliance and adherence with federal and state law, association and accreditation regulations.<\/p>

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        k. Ensure Health Services complies with regulatory requirements associated with Wellmarks participation on the Public Exchange; support and implement appropriate BCBSA policies and procedures.<\/p>

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        l. Manage and coordinate the dissemination of legislative and regulatory matters across Health Services and assist in the and prompt response to compliance concerns. Monitor legislative reports to identify impacts to Health Services. Partner with the business areas to effectively prioritize and resource compliance initiatives. Ensure business objectives are being met and details across programs are coordinated and executed. <\/p>

         <\/p>

        m. Other duties as assigned.<\/p>

Categories

Posted: 2020-05-19 Expires: 2020-06-18

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Director Health Services - Performance

Wellmark
Des Moines, IA 50309

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