Company :Highmark Inc.Job Description :
JOB SUMMARY
*Incumbent must reside in Southeastern PA
This job is responsible for the administration and maintenance of positive, collegial relationships between the corporation and the provider and health system community. The incumbent is responsible for engaging entities on performance-related activities such as Value-Based Reimbursement (VBR), Stars and Risk capture, as well as other organizational solutions as appropriate. Additionally, they will keep up with market trends and industry dynamics, including at both a macro and micro level (examples of micro level include changes/expansion of services provided by physicians), and current technologies to ensure the company is ensuring optimum outcomes for both the provider and corporation.
ESSENTIAL RESPONSIBILITIES
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Identify and cultivate relationships with providers in value-based arrangements outside of the Top 40 provider entities. Establish key contacts in all critical areas of the identified provider entity/system. Oversee administration of critical and timely communication to providers through ongoing personal contacts, site visits, regional communication sessions, meetings with professional organizations to communicate initiatives and changes.
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In partnership with the Market Executive, conduct analysis and make data driven decisions to ensure we are getting appropriate returns on investments for initiatives, increasing quality, lowering cost, and increasing patient satisfaction. Work with actuary and informatics teams to develop population health tools/reports, care alignment reports, and other resources that will produce value for Highmark, the provider partner, and the member.
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Utilize data to make informed decisions, negotiation skills to achieve desired results, and project management skills to ensure successful execution of commitments. Work collaboratively across the internal enterprise, establish networks to support provider engagement.
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Promote efficient communications in close partnership with Provider Engagement including coordination of provider advisory groups, forums and events hosted by Highmark.
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Identify, develop, and grow provider relationships through collaboration that will form the glide path for future transformation in care delivery and reimbursement models. This requires interfacing with various departments in the organization as well as vendor teams.
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Other duties as assigned or requested.
EXPERIENCE
Required
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7 years of experience in the health care/health insurance industry to include value-based care and provider relations/network management
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Experience with data analytics and trending
Preferred
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Experience working in provider or health system administrative or clinical role
SKILLS
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Strong interpersonal organizational and analytical skills
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Superior communication (written and oral), teamwork, organizational and leadership skills
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Strong understanding of health care quality programs such as STARS, HEDIS
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Understanding dynamics of matrix organization
EDUCATION
Required
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Bachelor’s degree or relevant experience and/or education as determined by the company in lieu of bachelor's degree.
Preferred
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Master's degree.
LICENSES or CERTIFICATIONS
Required
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None
Preferred
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None
Language (Other than English):
None
Travel Requirement:
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office- or Remote-based
Teaches / trains others
Occasionally
Travel from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
No
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
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Top Skills
What We Do
Highmark Health, a Pittsburgh, PA based enterprise that employs more than 40,000 people who serve millions of Americans across the country, is the second largest integrated health care delivery and financing network in the nation based on revenue. Highmark Health is the parent company of Highmark Inc., Allegheny Health Network, and HM Health Solutions. Highmark Inc. and its subsidiaries and affiliates provide health insurance to nearly 5 million members in Pennsylvania, West Virginia and Delaware as well as dental insurance, vision care and related health products through a national network of diversified businesses that include United Concordia Companies, HM Insurance Group, and Visionworks. Allegheny Health Network is the parent company of an integrated delivery network that includes eight hospitals, more than 2,800 affiliated physicians, ambulatory surgery centers, an employed physician organization, home and community-based health services, a research institute, a group purchasing organization, and health and wellness pavilions in western Pennsylvania. HM Health Solutions focuses on meeting the information technology platform and other business needs of the Highmark Health enterprise as well as unaffiliated health insurance plans by providing proven business processes, expert knowledge and integrated cloud-based platforms.
A national blended health organization, Highmark Health and our leading businesses support millions of customers with products, services and solutions closely aligned to our mission of creating remarkable health experiences, freeing people to be their best.
Headquartered in Pittsburgh, we're regionally focused in Pennsylvania, Delaware, West Virginia and New York, with customers in all 50 states and the District of Columbia.
We passionately serve individual consumers and fellow businesses alike. Our companies cover a diversified spectrum of essential health-related needs, including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative technology solutions.
We’re also proud to carry forth an important legacy of compassionate care and philanthropy that began more than 170 years ago. This tradition of giving back, reinvesting and ensuring that our communities remain strong and healthy is deeply embedded in our culture, informing our decisions every day.
