Wellmark Blue Cross and Blue Shield

Medical Director

• Use evidence-based decision making to perform inpatient case reviews.
• Synthesize clinical information to document a clear summary of medically necessary determinations.
• Make recommendations on efficiencies and innovations.
• Partner across the organization with other internal teams like Business Analytics and Claims.
• Participate in rotating on-call schedule for weekend and holiday reviews.

Medical Director – Inpatient Utilization Management

• Demonstrate ownership of overall effectiveness and efficiency of UM process.
• Provide leadership and day-to-day management of financial and human resources.
• Ensure efficient and effective performance of UM physician team.
• Responsible for oversight of independent review organization appeals.

Senior Medical Director – Utilization Management

• As Senior Medical Director for Utilization Management (UM), you will be an effective change leader and help develop and guide the strategic direction for Utilization Management initiatives at Wellmark.
• 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.
• You will strategically collaborate with the Health Services team and across the organization to develop and maintain accountability for initiatives to reduce overuse with results that are validated by Wellmark’s analytical team and are grounded in evidence-based care.
• You will perform oversight of independent review organization appeals and ensure effectiveness of end-to-end process for medical appeals.

Full-stack Engineer

• Design, develop, test, implement, maintain, and document software solutions in support of Wellmark’s business strategy and Technology vision.
• Ensure completed activities meet project specifications, requirements and Wellmark standards.
• Begin to establish and build working relationships with Technology and business units.
• Collaborate with other areas of Technology to ensure solutions improve the user experience, pass minimum accessibility or usability criteria.
• Participate in determining Technology alternatives and solutions and assist with system integration.
• Provide development and/or production support for key software applications and systems; define, analyze, estimate, develop, test, implement, document, and maintain programs and systems that meet business requirements.
• Contribute to solutions architecture deliverables and decisions, apply the reference architecture, contribute to reusable assets, and produce technical specifications sufficient for development teams.
• Partner and problem-solve with the UX team in the development of solutions that improve the user experience, pass minimum accessibility or usability criteria.
• Work to resolve technical problems for on premise, cloud native, and hybrid applications and solutions.
• Support the gathering of information, necessary research needed for root cause analysis, problem definition and formulation, solution implementation, verification, and ongoing optimization. Provide analysis of defects to find root cause.
• Provide recommended solution(s) that promote successful delivery of business project objectives or production support objectives and support benefits realization.
• Identify issues and think through challenges in the form of options and solutions; partner with others to identify resolutions and determine when to escalate when necessary.
• Communicate and provide regular updates and key information in a timely manner to leadership as well as the appropriate stakeholder audience.
• Collaborate and work as a team to accomplish goals and/or solve problems.
• Other duties as assigned.

Software Engineer – Senior

• Eligible to work remotely from home with required travel to Des Moines, Iowa during onboarding and quarterly thereafter.
• Develop and guide strategic direction for Utilization Management initiatives at Wellmark.
• Lead and manage team members, set clear expectations, coach, foster team-centric work environment.
• Serve as subject matter expert on effective and efficient processes to reduce overuse and improve quality for members.
• Collaborate with Health Services and across organization to develop and maintain accountability for initiatives to reduce overuse.
• Perform UM and appeals case reviews and provide oversight of independent review organization appeals.
• Provide leadership and day-to-day management of financial and human resources for UM team.
• Train and mentor physician team and facilitate ongoing team-based learning.
• Engage on peer-to-peer calls and escalated UM cases and consult with stakeholders.
• Oversee delegated specialty UM vendor clinical decision-making and audit UM decisions.
• Partner with Business Analytics to drive product development/new TCOC initiatives to reduce overuse.
• Perform other initiatives and projects as required.