Provider Network Program Manager

Wellmark • Des Moines, IA

9h • Hybrid

About The Position

As a Provider Network Program Manager, you will serve as a high-level individual contributor supporting network contracting and network management programs across all lines of business. You will partner closely with division leadership, program management, legal/compliance, technology teams, vendors, and key business functions to drive network contracting objectives and results. You will develop, monitor, and maintain provider network requirements, with a high focus on NSA/IDR, NCQA, QHP, and Medicare Advantage, while supporting network contracting, network management programs, and provider network initiatives in an evolving and dynamic environment. You will ensure compliance with federal and state regulations (such as CMS), BCBSA and Wellmark guidelines, lead cross-functional collaboration and internal education efforts, and act as a trusted “guest star” contributor for the Product Team. This position will work a hybrid schedule of at least 3 days (Tues-Thurs) in Wellmark’s Des Moines office with 2 days remote option (Mon/Fri). Internal Job Title : Network Program Manager

Requirements

• 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 (i.e. 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.

Nice To Haves

• Knowledge of federal and/or state regulatory requirements for Medicare Advantage and Qualified Health Plans.

Responsibilities

• 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).
• 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.
• Provide subject matter expertise in Medicare Advantage, Qualified Health Plan, and NQTL regulatory requirements.
• Develop and prepare materials for conducting internal and external meetings with partners and vendors and strategic initiatives and presentations across the organization.
• Establish and maintain strong relationships with internal stakeholders and vendor partners to champion the successful performance across all of Wellmark's Provider Networks.
• Ensure that assigned Network Contracting initiatives are well designed, coordinated, and activities are executed timely and effectively to achieve completion of milestones.
• Serve as lead and subject matter expert for Network Contracting for the Blue Cross Blue Shield Association and Blue Distinction Center programs.
• Other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 501-1,000 employees