Team Leader - Clinical Quality Management & Accreditation

About the role

Wellmark is a mutual insurance company dedicated to improving health care for its members. Founded over 80 years ago, it operates without profit motives, focusing instead on the well-being of its members. If you're passionate about contributing to an organization that prioritizes its members, provides excellent service, and promotes sustainability and innovation, consider applying.

Job Description

As a clinical quality leader, you will coach and mentor the Health Services Quality Management team to develop, implement, and monitor key health plan quality, clinical risk management, and accreditation programs. Your role will involve educating and guiding various parts of the organization to ensure these programs are ingrained in daily operations. You will also lead a team through change and foster a supportive work environment.

• Provide day-to-day leadership of financial and human resources, focusing on employee and leader coaching, development, performance improvement, coordination, and budgeting for Health Services Quality Program & Accreditation team.
• Drive the implementation of Wellmark's quality management functions, overseeing, planning, and implementing new and existing healthcare quality initiatives across the population.
• 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.
• 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.
• Ensure compliance with NCQA, federal, and state requirements for quality and HEDIS programs.
• Develop expertise and guidance for the team in writing program descriptions, evaluations, procedures, and state/federal documents.
• Support the Plan's NCQA, HEDIS, and other regulatory compliance functions.
• Demonstrate courage to lead change; comfortable with being a change agent within the team to meet organizational strategies and vision.

Qualifications

• Bachelor's degree and/or applicable work experience.
• 4+ years of diverse clinical health care related experience.
• Experience reflecting 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.
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• 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

This position requires a hybrid schedule of at least 3 days (Tues-Thurs) in Wellmark's Des Moines office with 2 days remote option (Mon/Fri).