Team Leader - Clinical Quality Management & Accreditation at Wellmark Inc

Des Moines, Iowa, United States -

Full Time

Start Date

Immediate

Expiry Date

14 Oct, 26

Salary

0.0

Posted On

16 Jul, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Clinical Quality Management, Accreditation, People Leadership, NCQA, HEDIS, Clinical Risk Management, Performance Improvement, Regulatory Compliance, Data Analysis, Crisis Counseling, Problem Solving, Stakeholder Management, Technical Acumen, Microsoft Office Suite, Electronic Charting, Program Evaluation

Industry

Insurance

Description

Company Description 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. Job Description About the Opportunity: Wellmark is on a mission to make health care better for our members and we are looking for an experienced clinical quality leader to help us drive this work! As a people-leader, you will coach and mentor the Health Services Quality Management team through the development, implementation and monitoring of key health plan quality, clinical risk management and accreditation programs to support Wellmark’s Total Cost of Care strategy. You will help us build programs that not only meet quality standards but also will be tasked with helping the organization ingrain this work into the day-to-day functions of the business. You will do this through actively partnering with various areas of the organization to help educate and guide them through their role in program success. As a leader of others, you will directly impact the success, growth, and development of team members by setting clear expectations, coaching to each team member’s strengths, and fostering a team-centric work environment. Being a role model in behaviors that demonstrate Wellmark’s Leader Success Expectations and inclusion are essential. In addition, you are skilled in leading through change and setting your team up for success by actively communicating and managing through ambiguity. You are a “people person” and love building organizational relationships and influencing others in a way that positively impacts the lives of our members. 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). Qualifications Required Qualifications: Bachelor's degree and/or applicable work experience. 4+ years of diverse clinical health care related experience. Experience must reflect two or more of the following: managed care, provider support, healthcare or health plan performance improvement, regulatory knowledge or quality improvement initiatives. Leadership skills typically gained through a combination of project or informal leadership that demonstrates knowledge of work processes, services, or leadership competencies. Ability to lead a diverse team through change. Prior regulatory and accreditation (NCQA, HEDIS) experience in both surveys and CMS and state program audits. Ability to use data to identify opportunities for improvement with the ability to make recommendations. Commitment to service excellence and member advocacy. Anticipates member and provider needs and takes appropriate actions; thinks critically and creatively yet understands resources and guidelines. Operates with agility, flexibility, and resourcefulness; effectively manages and adapts to change. Ability to organize multiple priorities and succeed in a dynamic work environment where quality goals are measured. Committed to timeliness, follow up, accuracy and detail. Strong verbal communication skills. Influences action and facilitates crucial conversations on care with members, physicians, and care facilities. Excellent crisis-counseling and problem-solving skills. Strong written communication skills, including accurate documentation of events within electronic documentation system; ensures quality and consistency by following set guidelines and processes. Demonstrated abilities in writing program descriptions, evaluations, procedures, and state/federal documents. (moved from job responsibilities). Develops collaborative relationships and maintains professionalism with peers, stakeholders, and members. Strong technical acumen; learns new technology and systems quickly - e.g., Microsoft Office Suite, electronic charting, documentation systems. Preferred Qualifications: Prior regulatory and accreditation experience in both surveys and audits in a formal or informal leadership capacity. Managed Care experience. Clinical licensure. Active and unrestricted clinical license, individual must be licensed in the state in which they reside. Additional Information What you will do: a. Provide day-to-day leadership of financial and human resources, primarily focusing on employee and leader coaching, development, performance improvement, coordination, and budgeting for Health Services Quality Program & Accreditation team. b. Drive the implementation of Wellmark's quality management functions including overseeing, planning, and implementing new and existing healthcare quality initiatives across the population. c. Support and manage Wellmark's accreditation activities and collaborate with core area leaders across the organization on their standards to assure monitoring and reporting of outliers/risks. d. Assure maintenance of programs for members in accordance with prescribed quality standards; conduct data collection, reporting, and monitoring for key performance measurement activities and provide direction and guidance for NCQA accreditation surveys as well for federal/state QI compliance activities. e. Assure compliance with NCQA, federal and state requirements for quality and HEDIS programs. f. Provides expertise and guidance to team in writing program descriptions, evaluations, procedures, and state/federal documents. g. Responsible for the written documentation and submission for regulatory and accreditation bodies. This includes the various program descriptions, program evaluations, policies and procedures, reports, and studies to ensure timely submission for audits/surveys. h. Support the Plan's NCQA, HEDIS, and other regulatory compliance functions. i. Comply with regulatory standards, accreditation standards and internal guidelines. j. Demonstrate courage to lead change; comfortable with being change agent within the team to meet organizational strategies and vision. k. Other duties as assigned. 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 [email protected] 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. Department: Clinical | Health Networks | Provider Support Work Environment: Hybrid Pay Grade: 24

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Responsibilities

Lead the Health Services Quality Management team in developing and monitoring clinical quality, risk management, and accreditation programs. Drive the implementation of healthcare quality initiatives and ensure compliance with NCQA, HEDIS, and state/federal regulatory standards.