Company :Allegheny Health Network
Job Description :
This job will strategically drive deployment of clinical programs and strategically deploy field facing clinical support resources such as Population Health Specialists, Population Health Pharmacists, Acute Care Highmark Resources, Specialist Efficiency Nurses, and supporting/integrating Project Management resources (including Agile) into the market of our provider partners. This includes supporting the development of new clinical programs that support our VBR, Population Health, and C2V objectives. These programs include but not limited to the Integrated Care Team (High Risk/Cost Member Management), Pharmacy Models, & many provider led clinical programs. This role is responsible for developing key relationships with the clinical/CIN operational leadership of our strategic partners. Key functions of this role include developing a deep understanding of a providers current state of clinical capabilities, identifying programmatic and operational gaps, driving many analytical dimensions such as population assessments, identification of risk and value drivers, deploying and enhancing predictive triggering and routing as well as ID & Strat methodologies, productivity trending and alignment, and development of key performance measures that align programmatically to the care management resources of the CIN thus promoting VBR success. Works collaboratively with other functions such as payer and provider relations, member services, benefits and claims management, credentialing, quality and peer review committees, etc.
- Responsible for overall development and strategic leadership of the clinically Integrated Network (CIN). Develop effective strategic and operational plans. Articulate and operationalize the strategic vision, translate it into tactical plans and communicate it to the key stakeholders of matrixed organizational partners. Oversee key operational initiatives, efficiencies, structure, and identify priorities that enhance overall performance. Drive innovation throughout the CIN in programs, technologies, member engagement, and partnerships.
- Develop and maintain strong relationships with employed and independent physicians, corporate and regional staff and peers both throughout the provider and Highmark enterprise to influence decisions and meet organizational mission and vision. Pursue opportunities for partnerships, collaborations, and new programmatic opportunities that may enhance the CIN. Perform 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.
- Make decisions based on verifiable and/or measurable data or criteria. Demonstrate a results-orientated and track record of achieving results by inspiring and mobilizing the skills and interests of others to accomplish common goals. Make difficult decisions, take action, and act as a change agenda as needed including high connectivity with physicians and provider staff.
- Accountable for developing a physician development plan, which includes retention and recruitment. Partner with providers to take an active role in specific CIN recruiting. Accountable for and provides professional leadership and direction to the quality improvement program and clinical quality management functions. Works collaboratively with other functions such as payor and provider relations, member services, benefits and claims management, credentialing, quality and peer review committees, etc. Assist in short and long range program planning, quality improvement and developing external relationships.
- Development of budget process and cycle for the CIN that is within the clinical and programmatic needs to achieve the value based goals. Oversee the development and annually update a long-range financial plan that supports the organization’s overall strategic plans and objectives. Monitor financial operations to ensure that the organization utilizes its resources in a fiscally responsible manner so as to assure the facility’s long-term sustained success in the future.
- CI Agile Team Development, Scaling as appropriate, and integration.
- Other duties as assigned or requested.
- Bachelor's Degree in Business, Nursing, Healthcare Administration or related field
- Master's Degree (Clinical)
- 10 years of working with internal and external healthcare stakeholders (e.g. physicians, clinical staff, and administration)
- 7 years in a Management or Supervisory role
- 5 years of working with True Performance & Value Based Designs
- 1 year with Agile methodology
LICENSES or CERTIFICATIONS
- Demonstrated ability to develop and maintain strong working relationships with colleagues at different levels of the business
- Demonstrated ability to deliver presentations of complex technical and business information to a diverse audience based upon a sound understanding of technology and its application to achieve business objectives
- Demonstrated excellent organizational skills, strong analytical and conceptual skills, and solid financial analysis skills coupled with demonstrated problem-solving skills
- Documented successful experience demonstrating strong capabilities regarding persuasion and influence
- Understanding of agile methodology
- Understanding of true performance and value based designs
Language (Other than English):
50% - 75%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Teaches / trains others regularly
Travel regularly from the office to various work sites or from site-to-site
Works primarily out-of-the office selling products/services (sales employees)
Physical work site required
Lifting: up to 10 pounds
Lifting: 10 to 25 pounds
Lifting: 25 to 50 pounds
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.
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