Company :Highmark Inc.Job Description :
JOB SUMMARY
This job works closely with management, and assists in developing new reimbursement models for the Organization's strategic partners and initiatives. The incumbent influences VBR integration into the overall Enterprise strategy through collaboration with Senior-level internal/external stakeholders. Ensures a high degree of development, efficiency, and effectiveness on the support and deployment of all VBR Design models.
ESSENTIAL RESPONSIBILITIES
- Support and lead, as needed, the development and completion of sales cycle (from model conception to implementation) of VBR programs for key strategic accounts and/or initiatives. Support strategic provider relationships to understand the current health care delivery state, readiness for change, test value based programming concepts and components, identify key partners, identify and proactively communicate market transformation concepts with provider and professional advocacy societies and key thought leaders.
- Ensure integration with Enterprise/PNR strategic direction. Collaborate with PNR stakeholders to incorporate VBR into product, network, and provider integration. Liaison with Enterprise & P&L leaders on their overarching strategies to ensure broader alignment of VBR approach. Develop targeted reimbursement models that support enterprise strategic initiatives that might fall outside of planned value-based reimbursement designs and/or to serve as a focus of innovation.
- Build collaborative relationships within the organization, external local, regional and national healthcare industry leadership to both inform market transformation strategies as well as to externally advance the organization's vision for care delivery transformation. Relationships will include internal areas of the enterprise such as the strategic, financial, and clinical leadership of the enterprise, in addition to the multiple areas of health plan.
- Support development of the overall conceptualization, strategy alignment, and high-level design of new value-based reimbursement models for PCPs, specialists, and health systems across the Organization's footprint, based on deep understanding and knowledge of trends in other areas of the country with both government and private payers. Programs will include but not be limited to pay-for-value programs, episode payments, prospective bundled payments, gain share and risk share models and will be implemented for the Organization's Medicare Advantage, Medicaid, ACA, and commercial populations with the goal of maximizing quality while reducing healthcare costs.
- Work with reimbursement, actuary, and analytic departments to ensure that operational capabilities are built in line with the strategic roadmap to ensure maximum flexibility and speed to market.
- Serve as a subject matter expert working in concert with provider relations and clinical transformation consultants to explain new programs and results to key provider partners.
- Collaborate with and support the senior Strategic Partners Consultant role as needed
- Other duties as assigned or requested.
EDUCATION
Required
- Bachelor's Degree in Public Health, Health Administration, Economics, Mathematics, Engineering, Marketing, Business Communications or related field
Substitutions
- 6 years of related and progressive experience in lieu of Bachelor's degree
Preferred
- Master's Degree in Public Health, Health Administration, Economics, Mathematics, Engineering, Marketing, Business Communications or related field
EXPERIENCE
Required
-
5 years in the Health Insurance industry, Healthcare industry and relationship management
Preferred
- 5 years of Consulting
- 1 year in a Provider facing role
- 1 year with Provider payment/reimbursement
- 1 year with strategic planning/corporate development
LICENSES AND CERTIFICATIONS
Required
- None
Preferred
- None
SKILLS
- Analysis of business problems/needs
- Consulting
- Innovation
- Oral & Written Communication Skills
- Problem Solving & Decision Making
- Project Management
- Strategic Partnerships
- Strategic Relationship Building
- Strategic Thinking
- Strategy
Language (Other than English)
None
Travel Required
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office-based
Teaches / trains others regularly
Occasionally
Travel regularly 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
Yes
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.
Pay Range Minimum:
$67,500.00
Pay Range Maximum:
$126,000.00
Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
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 their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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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.
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