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J180561

SVP Provider Transformation

Highmark Health

  • Company Hignmark Health
  • Pittsburgh, PA
  • Provider Services
  • Full time
  • Day (United States of America)

Company :

Highmark Health

Job Description : 

JOB SUMMARY

Highmark Health has a vision to reinvent the way that consumers and their clinicians engage in a person’s health which we call Living Health.  Central to that vision is the creation of a new health experience for both customers and clinicians, blending the clinician aspects in a way that is seamless and customized to a person’s health needs and their preferences for how they want to interact with the system.  This vision is meant to apply to all Highmark Health customers, whether they sit in Western PA where we have AHN, or in Idaho where they are a national account member.

A key part to making this vision work is to establish strong provider partnerships to enable the Living Health model and extend the reach, access, and effectiveness of an enhanced approach to the markets we serve, grounding our results along the Quadruple Aim plus growth.  Critical to this success is the ability to design and lead multi-year transformation across the provider systems to evolve delivery and operations to support an integrated approach to health.

The provider transformation dyad leadership team – the Provider Transformation Medical Director and the SVP of Provider Transformation - will be responsible for designing multi-year approaches to provider evolution focusing on a programmatic approach to system transformation that includes clinical, operational, and cultural drivers. They will also oversee and coordinate the initiation of the Living Health journey with provider partnerships, while acting as the conduit for transformation facilitation across cost, reimbursement, analytics, solutions and clinical inputs. The Provider Transformation Team will work closely with several other functions in the organization, particularly all members of the Living Health team (Solutions, Partnerships, Living Health markets, Data/Digital/Analytics, Customer Experience) and the clinical organizations in the network who will be responsible for delivery of care. The SVP Provider Transformation leader will be expected to, working with physician partners, align and drive  actions associated with the Provider Transformation strategy and execution, including coordinating the programmatic approach to Living Health within a partner provider system.   The VP will partner with the Provider Transformation Medical Director on all clinical decisions, but will have the primary responsibility of managing the relationship discussions while building and managing the administrative team to support the integration of Living Health into the strategic planning process of the partner providers. 

ESSENTIAL RESPONSIBILITIES

  • Co-Lead the development and ongoing refresh of the Highmark Health strategy for provider transformation.  That strategy will include a multi-year approach to transformation, inclusive of all system levers and capital funding considerations, market inputs and clinical service contributions (both clinically and administratively), and where innovation will take place.  All of this will be done in the context of the broader Living Health strategy. 
  • Be a resource to the LH Solutions team in the solution development process.
  • Co-lead the build-out and coordination of the delivery network needed to drive adoption of the portfolio of scaled solutions, with particular emphasis on how system partners and their clinicians in our network fit into the broader spectrum of solutions.
  • Represent the administrative/business point of view on relevant decisions related to the identification, build-out and management of technology needed to support operational changes in line with overall objectives.
  • Drive the development of the implementation framework, playbook, and approach for bringing the provider transformation construct to all partner organizations and then building the organizational infrastructure and resources to support framed in the Quadruple Aim.
  • Serve as an ambassador for Highmark Health and its strategy to partner clinical organizations in partnership with the Provider Transformation Medical Director.
  • Work in concert with Living Health Solutions team to monitor ongoing effectiveness of virtual health solutions.
  • Establishes clear lines of responsibility and accountability within Provider Transformation team. Ensures collaboration and sense of urgency around process implementation and improvement/optimization.
  • Performs management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.
  • Provide other duties as assigned.

EDUCATION

Required

  • Bachelor's Degree

Substitutions

  • None

Preferred

  • Master's Degree

EXPERIENCE

Required

  • 10 years in a management role for a large, matrixed organizational structure
  • 5 years managing a large portfolio of solutions/products and outcomes
  • 7 years in Executive/Clinical leadership roles including responsibility for fiscal and staff management 
  • Experience leading large scale organizational transformation from strategy development through execution and value realization.
  • Experience with health plan operations, provider operations, and leadership is strongly preferred, experience with IDFS organizations is preferred 

Preferred

  • Deep knowledge and understanding of contemporary leading practice in health plan or provider operations across integrated payer and provider systems
  • Capacity to execute both short-term wins and long-term strategies and ability to implement enterprise-wide initiatives
  • Proven leadership skills spanning multiple organizations and complex relationships
  • Strong ability to influence change in a highly-matrixed environment
  • History of successful cross-continuum and management capabilities
  • Strong verbal and written communication skills
  • Ability to organize, prioritize, and accomplish multiple, complex tasks simultaneously
  • Ability to strategically leverage data and analytics to guide decision making and monitor organizational performance
  • Strong mediation, diplomatic and negotiation skills
  • Experienced balancing multiple strategic priorities

LICENSES or CERTIFICATIONS

Required

  • None

Preferred

  • None

SKILLS

  • Keen eye for detail and ability to design and convey leading edge solutions to transform health
  • Strong oral and written communication skills, can visually convey concepts
  • Managing through some levels of ambiguity. Ability to create a function “from scratch”
  • Experience in matrix management, including own function and providing matrix oversight to others

Language (Other than English):

None

Travel Requirement:

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.

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, 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, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

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. 

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.

For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

California Consumer Privacy Act Employees, Contractors, and Applicants Notice


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