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Wellmark - Des Moines Policy, Compliance & Regulatory Manager-Network in Des Moines, Iowa

Use your strengths as Policy, Compliance & Regulatory Manager - Network

In this newly created role, you'll support the management, coordination, and completion of Network Administration policy changes and projects that are complex and cross-functional in design. You'll interpret state/federal regulations, BCBSA changes, and will provide insight to stakeholders regarding regulations and changes which may impact Network Administration, and potentially other cross functional areas. This work requires collaboration, so you'll partner with our Legal, Compliance, and Government Relations teams in the interpretation of regulations in support of business-specific planning and execution. In addition, you'll serve as the department SME for PolicyTech, monitor specific policy system functionality/capabilities, and partner with internal stakeholders on prioritization of related implementations and enhancements.

Our strongest candidates are proactive, driven, and love spending time in the details. (A good day includes reviewing the Federal Register!) They're also effective at summarizing and communicating findings, both verbally and in writing.

Required:

  • Bachelor's degree in a related field or direct and applicable work experience.

  • 4+ years of work experience in a health care clinic, state/federal licensing board, insurance operations, provider network administration, contracting, credentialing, medical policy, or similar area.

  • Demonstrates the ability to review, analyze, and interpret regulations/guidelines and provide insights or recommendations.

  • Project management or business process experience. Ensures projects meet quality, time, and stakeholder expectations, and effectively manages, competing priorities in a fast-paced, dynamic work environment.

  • Excellent analytical, research, and critical thinking skills.

  • Strong attention to detail. Ability to monitor, collect, or record data and assess its accuracy, validity, or integrity.

  • Excellent verbal and written communication skills. Presents and articulates complex information clearly and effectively to a variety of stakeholders, both internally and externally.

  • Ability to consult with stakeholders, apply subject matter expertise and influence decisions appropriately.

  • Proficient with Microsoft Office (e.g., Word, Excel, Outlook) and web-based applications (e.g., PolicyTech), with the ability to learn new technology quickly.

  • Ability to measure and evaluate work processes and utilize appropriate resources to identify opportunities or implement solutions.

  • Flexible and adaptable to change. Ability to lead others through change.

Preferred:

  • Bachelor’s degree.

  • Exposure to Medicare rules/regulations is a plus.

a. Support the management, coordination, and completion of projects that are complex and cross-functional in design, along with the planning and implementation of Network Administration policy changes and projects utilizing PolicyTech. Own the creation of Policies/Procedures in Policy Tech and serve as the department SME for PolicyTech.

b. Accountable for review of all weekly/published regulatory/compliance publications that are received from Compliance team. Read and interpret state and federal regulations (including BCBSA changes) impacting Network Administration and provide insight to the business and help assess impacts. Manage annual self-compliance audit process with Network Administration team and Compliance.

c. Monitor and analyze new and changing regulatory requirements and assist in aligning change to achieve project objectives. Work with legal area to obtain interpretation of regulations in support of business execution.

d. Ensure state and federal regulation related activities are monitored, tracked, and resolved appropriately according to established policies and procedures.

e. Keep Network Administration informed of system functionality and capabilities and partner on prioritization of implementation and enhancements. Recommend and implement policy and solution changes to business processes to enhance and obtain better efficiencies for the department and division.

f. Establish and maintain effective partnerships and perform in the role of liaison and coordinator between Network Administration and the Legal, Compliance, and Govt Relations teams as well as other internal stakeholders involved in corporate and department project initiatives.

g. Meet with/address needs of Annual Compliance Risk Assessment (schedule meeting, create agenda, facilitate survey completion, create action plan and monitor). Lead any communication needs related to key regulations and Network Administration impacts and collaborate with others to ensure appropriate messaging.

h. Other duties as assigned.

Posting Title: Policy, Compliance & Regulatory Manager-Network

Requisition ID: 214930

REQUIRES NON-COMPETE?: No

External Company Name: Wellmark Blue Cross and Blue Shield

External Company URL: www.wellmark.com

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