Provider Network Strategy & Contracting Consultant

Wellmark, Inc.•Des Moines, IA

3h•Hybrid

About The Position

This position plays a critical, hands-on role in advancing complex provider network agreements that support the organization’s broader business strategy. The role is deeply involved in high-level, fee-for-service and value-based negotiations, significant contract drafting, and working in close partnership with Legal to translate business needs into well-structured, executable agreements. While leadership retains oversight and leads the most senior-level negotiations, this role operates as the “boots on the ground” partner driving work forward, progressing multi-year agreements, preparing executive-level materials, and ensuring momentum from strategy through execution. Collaboration with Network Contracting, Network Performance, and Network Payment Strategy teams is essential to align contract terms with performance objectives, business initiatives, and the total cost of care strategy.

Requirements

Bachelor's degree or direct and applicable work experience.
5+ years of progressive experience in provider network contracting, demonstrating strong knowledge of contracting strategies, contract setup and execution, and applicable regulatory requirements within a healthcare environment.
Advanced analysis, negotiation, influence, and relationship-management skills, with the ability to execute complex provider contracting initiatives aligned to enterprise strategy and business objectives.
Demonstrated ability to lead through expertise and influence, providing guidance, consultation, and informal mentoring within cross-functional and matrixed environments, without direct people-leader responsibility.
Strong operational problem-solving and troubleshooting capabilities, with the intellectual aptitude to understand healthcare industry dynamics, evaluate complex issues, and develop practical, sustainable solutions.
Highly developed critical-thinking skills, with the ability to creatively apply data and insights to drive process improvements, strategic alignment, and positive business outcomes.
Excellent written and verbal communication skills, with the ability to clearly convey complex information, recommendations, and contracting considerations to a variety of audiences, including providers and internal stakeholders, adapting messaging as appropriate.
Partners effectively with different business areas. Proven ability to succeed in a dynamic, fast-paced environment, driving results through collaboration and effective partnership with diverse business areas.
Proven ability to succeed in a dynamic, fast-paced environment, driving results through collaboration and effective partnership with diverse business areas.

Nice To Haves

Bachelor’s degree (if not already met through experience), with advanced education or specialized training in healthcare, business, or a related field a plus.
Health plan value-based performance and contracting experience.
Proficiency in HROR highly preferred.

Responsibilities

Partners cross-functionally to support the development and execution of Wellmark and BCBSA network strategies, maintaining accountability for assigned contract initiatives and ensuring alignment with enterprise priorities.
Applies advanced analysis to evaluate network performance and design provider-specific contracting and methodology strategies, while supporting the governance and continuous improvement of contracting policies, procedures, work instructions, and program documentation.
Executes complex fee-for-service and value-based provider contract negotiations, ensuring agreements align with Wellmark’s quality, financial, and regulatory standards while supporting long-term network sustainability.
Leads the operational implementation of new and evolving value-based payment models, ensuring consistency with network strategy, payment methodology, and provider readiness.
Serves as a subject matter expert for escalated provider contract and network status issues, providing expert guidance and resolution support to internal stakeholders.
Collaborates with internal partners to assess provider network composition and adequacy, leveraging data and market insights to develop recommendations for network expansion, optimization, or contractual modifications.
Partners closely with Network Contracting, Network Payment Strategy, and Legal to support the drafting, execution, and maintenance of provider contracts and amendments, ensuring accuracy, consistency, and compliance.
Applies advanced critical-thinking and problem-solving capabilities to evaluate complex issues, assess alternatives, and develop innovative, data-driven solutions in collaboration with internal teams and external partners.
Manages multiple complex initiatives concurrently, demonstrating strong organizational, prioritization, and execution skills in a dynamic and evolving business environment.
Builds and sustains effective provider relationships through proactive communication regarding contract initiatives, changes, and new opportunities, ensuring clarity, alignment, and coordination across stakeholders.
Leads department-level and cross-functional initiatives using established business and process-management tools to support strategic execution and operational consistency.
Acts as a primary liaison with healthcare organizations on value-based contracting matters, ensuring alignment with contracting, network payment strategy and enterprise objectives.
Other duties as assigned.