Director - Cost of Care

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 upstream and downstream 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 partner 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 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.

Responsibilities

• Drive and facilitate the creation of detailed multi-year business cases for Health & Pharmacy Services initiatives, including investment/cost, medical/RX claims savings, administrative savings, revenue growth, return on investment, member impact, and provider impact.
• Work closely with the Business Analysis/Data Science team and HPS leadership to achieve business case objectives.
• Provide day-to-day leadership of financial and human resources, focusing on employee and leader coaching, development, performance improvement, coordination, and budgeting for multiple staff and department-specific functions/services.
• Leverage health care and pharmacy expertise to identify and assimilate relevant insights for informed decision-making, partnering with Health & Pharmacy Optimization teams.
• Drive the identification, creation, and maintenance of cost of care metrics to support stakeholders in understanding baseline values, quantifying program value, and forecasting upcoming initiatives.
• Partner in the development and management of performance reporting (e.g., dashboards) to facilitate effective measurements and outcomes.
• Monitor and track aggregate performance against annual and long-term goals and core business objectives.
• Conduct root cause analysis, determine key drivers of performance, and forecast future performance and outcomes.
• Analyze and identify strategically significant industry trends for potential overuse based on medical technology innovation pipelines, measuring against Wellmark-specific and national benchmarks.
• Identify dependencies, links, and impacts across various initiatives, ensuring alignment, coordination, and collaboration among stakeholders.
• Inspire trust and confidence in all stakeholders through strategic and diplomatic relationship handling.
• Establish and build advisory relationships to drive effective delivery of strategic business outcomes.
• Present and consult on initiative performance results, partnering with stakeholders to develop and drive improvement plans for underperforming initiatives.
• Other duties as assigned.

Requirements

• Bachelor’s degree in business, health care administration, or a related field, or equivalent experience.
• Minimum of 7 years of experience leading complex, cross-functional strategic programs, including research, concept, and optimization development.
• Experience implementing transformation strategies, change leadership, and balancing business, financial risk, and superior service to a member base.
• Minimum of 5 years of demonstrated broad-based health care and/or pharmacy background.
• Strong knowledge of health regulatory and accreditation standards.
• Excellent abilities in leveraging health care and/or pharmacy insurance industry knowledge, including product design/management, delivery systems, and managed care concepts.
• Proven success building and sustaining relationships based on competence, trust, and mutual respect to quickly build rapport, credibility, and collaborative partnerships.
• Strong technical abilities to establish and measure results through sound metrics, including experience with quality measurement tools and efficiency/cost measurement tools.
• Evidence-based decision-making skills; ability to review past history, benefits information, policies, financial data, and other data to make informed decisions in a timely manner.
• Executive presence and ability to effectively synchronize and drive work holistically across the enterprise, communicating complex information to varied audiences, including senior leadership and the Board of Directors.
• Demonstrated leadership experience, including building and developing high-performing teams, establishing clear goals, and motivating teams to achieve success while adapting to changing priorities.
• Product management mindset for end-to-end project success, including financial, business, and operational results.
• Strong critical thinking abilities to evaluate complex systems and processes, creating and implementing recommended changes to increase quality and efficiencies.
• Some travel may be necessary.

Preferred Qualifications

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

Why Wellmark

We are a mutual insurance company owned by our policyholders across Iowa and South Dakota, built on over 80 years of trust. We are motivated by the well-being of our friends, family, and neighbors—our members—not profits. If you’re passionate about joining an organization committed to putting its members first, providing best-in-class service, and driving sustainability and innovation, consider applying today.

Learn more about our unique benefit offerings here.

This job requires a non-compete agreement.