Director - Provider Network Contracting

Wellmark•Des Moines, IA

19h•Hybrid

About The Position

Wellmark’s Director of Provider Network Contracting provides strategic direction and leadership for the organization’s highest-level provider network contracting initiatives and negotiations. The role is accountable for prioritizing programs, strategic planning, and executing complex provider agreements. It partners with Network Contracting, Network Payment Strategy, Provider Relations, Payment Integrity, Legal, Operations, and other business areas to develop contracting and provider payment strategies that support network cost of care, quality and outcomes, and long-term sustainability. The Director oversees sophisticated provider network initiatives to mitigate risk, improve quality and affordability for members, and ensure contract performance and enterprise outcomes. The role promotes teamwork and collaborative relationships in a highly matrixed environment, bringing department functions together across the organization. It leads complex negotiations and provider network strategies across commercial and government programs, and represents Wellmark with external stakeholders. This position requires a non-compete agreement. The position follows a hybrid schedule, with at least three days (Tuesday through Thursday) in Wellmark’s Des Moines office and the option to work remotely on Mondays and Fridays. Directors may be asked to work in the office on Mondays or Fridays periodically to meet business needs. Ability to travel as needed is required.

Requirements

Bachelor’s degree or direct and applicable work experience.
At least 7 years of healthcare industry experience focused on provider contract work, demonstrating success and expertise in provider network contracting strategies, setup, and regulations, or related industry experience.
Experience in commercial and value-based arrangements, relationship management with providers such as physicians and hospitals, strategic consultation, and analysis of data or information.
Strong negotiation, influence, and relationship management skills, emotional intelligence, and business aptitude.
Ability to interpret network analytics, quality and clinical outcomes, claims data, and trends to assess provider utilization and determine benchmarks.
Demonstrated superior negotiation, communication, and critical-thinking skills.
Strong understanding of contract negotiation and administration principles and practices, including complex contract provisions.
Formal leadership experience and ability to lead, coach, engage, and develop team members in a dynamic, changing, matrixed environment.
Experience setting team goals, aligning resources, and achieving results.
Ability to synthesize data into actionable recommendations, think critically and creatively, and drive continuous improvement.
Experience analyzing, forecasting, and modeling financial and budget data.
Advanced analysis, problem-solving, and research skills, and ability to use data to inform decisions and improve outcomes.
Excellent written and verbal communication skills, including presenting recommendations to executives and providers and adapting communication to the audience.
Strong change leadership skills, including defining a future state and inspiring others to embrace the strategy.
Ability to challenge the status quo while maintaining diplomacy.
Ability to thrive in a dynamic environment and deliver results through collaboration across business areas.
Ability to travel as needed.

Nice To Haves

Master’s degree.
Business and industry acumen.
Prior experience leading people-leaders.
Experience leading high-impact provider network negotiations.
Additional experience in network analytics and network performance.

Responsibilities

Lead and direct complex provider network contract negotiations, serving as primary strategist and decision-maker for high-value, complex provider agreements.
Develop negotiation strategies that balance affordability, quality, risk mitigation, and network sustainability while aligning stakeholder interests and achieving enterprise objectives and favorable contractual and financial outcomes.
Manage financial and human resources, including coaching and developing employees and leaders, performance improvement, coordination, and budgeting for multiple staff and department functions.
Communicate strategy and initiatives to team members and support customer and stakeholder service and company results.
Evaluate and develop strategic plans for network expansion or change to meet company goals, partnering across the Network team for commercial and government networks and products.
Use claims trends, network performance metrics, and market intelligence to inform contracting strategies, manage network costs, and support data-driven decisions; partner across functions to resolve complex business, financial, and technical challenges.
Share provider network contracting strategies for commercial and government programs with stakeholders, obtain feedback, and support alignment with long-term network development and product growth goals.
Develop and implement large-scale provider network strategies, including network development and expansion, network design, performance optimization, commercial value-based payment models, provider initiatives, and provider data operational efficiencies.
Represent the department and Wellmark on network contracting and payment strategy with external audiences, including health systems, hospitals, physicians, national health care organizations, BCBSA, and other stakeholders.
Serve as a subject matter expert and thought leader for internal departments resolving escalated provider contract and network status issues.
Lead department, division, and cross-functional projects and encourage effective use of process management tools and programs.
Perform other duties as assigned.