Director - Cost of Care

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 here.

About the Role: As a vital member of the Wellmark leadership team, you will directly drive critical business strategy and outcomes as well as align leadership around Wellmark's total cost of care (TCOC) initiatives. Total cost of care cannot be viewed independently because it involves many intertwined initiatives with up and down stream impacts, this position must leverage health and/or pharmacy clinical (pharmacy preferred) expertise to effectively synchronize, influence, and drive forward decisions holistically across the enterprise.

As a Cost of Care Director, you will serve as a trusted advisor to Health Care Innovation (HCI) leadership and will be viewed as a matrixed leader among others across the organization. You will be responsible for partnering extensively with internal stakeholders to implement and measure the success of cost of care initiatives - driving strategy and ideas through the creation and facilitation of multi-year business cases for Health Care Innovation (HCI) initiatives. You'll support initial sizing and business case analysis and partner with project and initiative resources across various Wellmark departments to achieve results.

Preferred Qualifications - Great to have:

• Master's degree in business (MBA).
• Health plan experience.

Required Qualifications - Must have to be considered:

• Bachelor's degree in business, health care administration or related field, or equivalent experience.
• Minimum of 7 years of experience that reflects expertise, success, and demonstrated experience leading complex, successful cross-functional strategic programs, including research, concept, and optimization development. Experience implementing transformation strategies, change leadership and a demonstrated understanding and application of how to balance the business, financial risk and superior service to a member base.
• Plus, a minimum of 5 years of demonstrated broad-based health care and/or pharmacy background. Must have strong knowledge of health regulatory and accreditation standards.
• Excellent abilities in leveraging health care and/or pharmacy insurance industry knowledge, which may include product design/management, delivery systems and managed care concepts, along with technical expertise, and proven success building and sustaining relationships based on competence, trust, and mutual respect, to quickly build rapport, credibility, and collaborative partnerships with team members, senior leaders, and stakeholders (including vendors and providers).
• Strong technical abilities needed to establish and measure results through sound metrics; experience with measurement tools and analysis including the use of quality measurement tools and efficiency/cost measurement tools.
• Evidence-based decision-making skills; ability to review past history, benefits information, policies and financial as well as other data to make sound, informed decisions in a timely manner.
• Must have a keen ability to effectively synchronize and drive forward work holistically across the enterprise, with an executive presence, to effectively communicate, consult on, and deliver complex information (i.e., dataset presentation) with varied audiences, such as internal and external leaders, team members, vendors, or customers, which also includes senior leadership and Board of Directors.
• Demonstrated leadership experience, including building/developing high performing teams. Establishes clear goals/expectations and motivates teams to achieve success and is flexible and adaptable to changing priorities.
• Requires a product management mindset for overall end-to-end success of projects including financial, business, and operational results. Strong abilities in utilizing critical thinking to evaluate complex systems and processes; create and implement recommended changes to processes and organizational structure to increase quality and efficiencies.
• Some travel may be necessary.

What you will do as a Director of Cost of Care:

a. Accountable for driving and facilitating the creation of detailed multi-year business cases for initiatives for Health & Pharmacy Services that includes but is not limited to the following: investment/cost, medical/RX claims savings, administrative savings, revenue growth, return on investment, member impact and provider impact. Works closely with Business Analysis/Data Science team and HPS leadership in achieving this.

b. Provide day-to-day leadership of financial and human resources, primarily focusing on employee and leader coaching, development, performance improvement, coordination and budgeting for multiple staff, and department(s) specific functions/service.

c. Leverage health care and pharmacy expertise to partner in identifying and assimilating relevant insights to ensure informed decision-making, which is appropriate to objectives. This includes solid partnership and work with Health & Pharmacy Optimization teams.

d. Accountable for driving the identification, creation, and maintenance of cost of care metrics to support key stakeholders in the understanding of baseline values of cost of care metrics, quantifying the value of existing programs, and forecasting the value of upcoming initiatives. This includes partnering and driving the development and management of performance reporting (i.e. dashboards) to facilitate effective measurements and outcomes.

e. Monitor and track aggregate performance against annual and long-term goals and additional core business objectives. Conduct root cause analysis and determine key drivers of performance including forecasting of future performance and outcomes.

f. Accountable for analyzing and identifying strategically significant industry trends for potential overuse based on pipeline of medical technology innovation and measuring against Wellmark-specific and national benchmarks. Identify dependencies, links, and impacts across various initiatives. Ensure alignment, coordination, and collaboration among relevant stakeholders.

g. Inspire trust and confidence in all stakeholders through strategic and diplomatic handling of relationships. Establish and build advisory relationships to drive the effective delivery of strategic business outcomes.

h. Present and consult on results of initiative performance and continually partner with stakeholders to develop and drive improvement plans for initiatives that are under performing.

i. Other duties as assigned.

This job requires a non-compete agreement.

An Equal Opportunity Employer

The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.

Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at careers@wellmark.com

Please inform us if you meet the definition of a "Covered DoD official".

At this time, Wellmark is not considering applicants for this position that require any type of immigration sponsorship (additional work authorization or permanent work authorization) now or in the future to work in the United States. This includes, but IS NOT LIMITED TO: F1-OPT, F1-CPT, H-1B, TN, L-1, J-1, etc. For additional information around work authorization needs please refer to the following resources:Nonimmigrant Workers and Green Card for Employment-Based Immigrants

Wellmark supports and expects the responsible use of AI for our workforce! We welcome the responsible use of these tools by job seekers as well and are interested in learning from you; you will have an opportunity in the application process to share which tools you used and how you applied them.