Network Program Manager

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 .

Job Description

About the position :

This role is a high-level individual contributor responsible for supporting network contracting and network management programs across all lines of business. You will effectively collaborate with division leadership, program management, technology, vendor partners and business functions to drive and achieve Network Contracting objectives and key results. You will develop and provide ongoing monitoring of provider network requirements including NCQA, Qualified Health Plans (QHP) and Medicare Advantage (MA) network filings, network contracting, network management program support, and provider network initiative execution. You will ensure the department maintains all requirements in accordance with new and existing Federal and State regulations, BCBSA and Wellmark guidelines. You will support internal education, coordinate and manage cross-functional workgroups, and function as a key guest star for the [Agile] Product Team.

This position will work a hybrid schedule of at least 3 days (Tuesday, Wednesday, Thursday) in Wellmark's Des Moines office, with 2 days (Monday, Friday) remote option.

Qualifications

Required Qualifications :

• Bachelor's degree or direct and applicable work experience.
• 3+ years of progressive project and / or program management experience with at least 2 of those years reflecting experience in a health care setting.
• Minimum of 1 year experience working in government business ( Medicare, Medicaid, ACA).
• Track record of success leading complex programs / projects. Demonstrates effective understanding of interdependencies, decision making, and resource management.
• History of collaborative relationships with executives, stakeholders, operational teams, and / or vendor partners.
• Track record of successful execution through critical thinking and problem solving, trust, cooperation, influence, and conflict resolution.
• Highly analytical, with the ability to successfully problem solving and think critically in a fast-paced environment.
• Proactive, resourceful self-starter with effective prioritization skills and strong attention to detail.
• Preferred :
• Knowledge of federal and / or state regulatory requirements for Medicare Advantage and Qualified Health Plans.

Additional Information

What you will do as a Network Program Manager :

a. High level individual contributor who will function as the Network Contracting subject matter expert for NCQA, Mental Health parity (MHPHEA), network adequacy, government programs network filings, and Consolidated Appropriations Act (CAA).

b. Coordinate execution of Network Contracting program initiatives, projects and strategies that support business objectives through coordination with Health Network and Government Programs leadership, Network Contract Managers and additional stakeholders, serving as a subject matter expert or guest star for strategic workgroups or within Wellmark's Agile Product model.

c. Provide subject matter expertise in Medicare Advantage, Qualified Health Plan, and NQTL regulatory requirements.

d. Develop and prepare materials for conducting internal and external meetings with partners and vendors and strategic initiatives and presentations across the organization.

e. Establish and maintain strong relationships with internal stakeholders and vendor partners to champion the successful performance across all of Wellmark's Provider Networks.

f. Ensure that assigned Network Contracting initiatives are well designed, coordinated, and activities are executed timely and effectively to achieve completion of milestones.

g. Serve as lead and subject matter expert for Network Contracting for the Blue Cross Blue Shield Association and Blue Distinction Center programs.

h. Other duties as assigned.