Provider Performance Manager (Commercial / Value-Based)

Preferred Qualifications - Great to have

• Experience in value-based contract management, network performance and contracting. Experience also in roles focused on relationship management (e.g. physician, hospital), strategy, consultation, and analysis of data/information.

Required Qualifications - Must have

• Bachelor's degree or direct and applicable work experience.
• 4+ years of related healthcare industry experience that reflects analysis of health care quality data and network management or provider relations.
• Ability to build and maintain relationships with colleagues and external stakeholders.
• Effective consultation skills, including the ability to persuade and influence key decision makers.
• Demonstrated ability to communicate effectively verbally and in writing, expressing complex concepts clearly and concisely with multiple levels of an organization, including external stakeholders and professional organizations. Ability to develop and facilitate presentation as needed.
• Ability to apply strong analytical, problem solving, and critical and strategic thinking to work with vendors and internal departments. Willingness to take an innovative, creative approach to solving problems and developing solutions.
• Self-starter motivated by the opportunity to work in fast-paced environments and driven by measurable outcomes. Ability to operate independently yet cooperatively on teams to appropriately manage priorities while maintaining positive relations.
• Strong organization, time management, and prioritization skills. Ability to manage multiple projects while adjusting to changing priorities and business needs.
• Ability to develop and maintain documentation of processes and procedures and make decisions by following established guidelines.
• Proficiency with Microsoft Office applications, such as Word, Excel, Outlook, PowerPoint or Access.
• Travel required up to 10%. Valid driver's license.

What you will do as a Network Performance Manager

• a. Work collaboratively with key healthcare organizations, physicians, physician aggregators and other strategic stakeholders to develop and achieve action plans, quality performance benchmarks, and total cost of care objectives to enhance health care organization performance. Provide ongoing monitoring and management of provider performance opportunities for total cost of care and quality benchmarks related to value-based payment initiatives and ensure strategic focus is on target with overall company strategy. b. Accountable for key health care organization, physicians, physician aggregators and other key healthcare organizations network performance management by conducting management committees and joint operating committee meetings and presenting as needed in order to effectively review value-based contract compliance and performance. Recommend strategies and specific actions to improve managed care performance in terms of utilization, patient access, cost of care, compliance with contractual quality measures, etc. c. Negotiate competitive and complex, value-based contractual relationships with health care organizations, physicians, physician aggregators, and strategic stakeholders according to Wellmark guidelines and quality and financial standards. d. Individual will be responsible for the execution and/or implementation of new value-based models and/or execution/implementation of changes to existing value-based models with health care organizations. e. Continually assess external environment and emergence of value-based contracting and network performance activities and implications for Wellmark, including analyzing and preparing information to facilitate decision-making. f. Serve as liaison to health care organizations regarding value-based contract issues and ensure consistency with network payment strategy. g. Demonstrate knowledge and support of corporate initiatives related to health care organizations engagement, quality and efficiency of care, and prioritize work activities to support them. h. Other duties as assigned.

This job requires a non-compete agreement.