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J183524

VP, Medicaid Business & Cost Management

Highmark Inc.

  • Company Highmark
  • Pittsburgh, PA
  • Finance
  • Full time
  • Day (United States of America)

Company :

Highmark Inc.

Job Description : 

JOB SUMMARY

This job develops and executes the overall business management practices of the Medicaid Business Unit to ensure alignment with organizational strategy as well as population health, clinical, operational and financial performance objectives. The incumbent provides the leadership, management and vision necessary to establish and execute the Medicaid business management capabilities for process management, project portfolio management, project management, vendor product management and innovation.  The business management capabilities include, but are not exclusive to, operational modeling, process engineering and improvement, organizational design, as well as governance, control and performance reporting to enable our care management, customer services and contractual/regulatory commitments to our Medicaid members, providers and regulators.  This job drives service delivery solutions and business management for Government Markets Medicaid Business.  Responsible for building out and implementing capabilities and solutions for Medicaid customers (existing and future) to achieve revenue and profitability targets.

ESSENTIAL RESPONSIBILITIES

  • 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.  Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
  • Provide leadership of the business process management capability and resources for Medicaid Markets.  Business process management encompasses process improvement and innovation initiatives across multiple functional units for both strategic and continuous process improvement efforts. Strategic and transformational support includes design and support throughout implementation to assure people/process/technical solutions align with strategic initiative while driving consensus among business units including process ownership and governance. Design activities include the documentation, management and oversight of end to end workflow process analysis assuring improved productivity, cost effectiveness, appropriate embedding of key performance Indicators, and appropriate controls for both regulatory and compliance considerations. Provides consultative services and analytic support to business management leveraging LEAN practices, Six Sigma methodologies and tools, work simplification, service level management, organizational design, consolidation, performance measurement systems, productivity improvement and expense control. Assimilates business process with RPA (Robotic Process Automation) opportunities from ideation and design to execution.
  • Provide leadership of the Project Management Office (PMO) capability and resources for Medicaid Markets.  The PMO encompasses business unit project portfolio management, large-scale program management, project management execution and organizational learning of project management.  Through project portfolio management, the PMO will enable the generation of Medicaid initiatives and projects, evaluation of the efficacy and prioritization of projects, and track overall projects performance, enabling leadership visibility and engagement in risks, issues, decisions and deliverables.  For large-scale and/or complex programs and projects, the PMO will provide the program/project management leadership and resources to successfully fulfill project objectives.  The PMO will follow project management industry best practices, specifically inclusive of the Project Management Institute and Highmark business practices.
  • Provide leadership of the medical cost and risk revenue capabilities of the Medicaid Business Unit.   This role is responsiblthe for the strategy development and overall management of the cost analysis, solution identification, effort prioritization and initiative implementation necessary to deliver our Cost-to-Value (C2V) initiatives and maximize risk revenue.  Provides leadership to a highly matrixed team that will execute a consistent and disciplined process to achieve the targeted results necessary for Medicaid to succeed. Accountable for ensuring that delivery of 1) a strategy and playbook to execute our C2V and risk revenue actions, 2) an overall framework and governance process to make decisions regarding initiative go/no-go and resultant implementation timing, 3) establish and manage a process to review all scheduled initiative implementation timing on a periodic basis to make sure it aligns with overall strategic intent, and 4) establish and manage a comprehensive framework and supporting process for communication of C2V and risk revenue initiatives implementation impacts, both planned and actual, to both internal and external constituents.
  • Other duties as assigned or requested.

EDUCATION

Required

  • Bachelor Degree in any of the Business Areas, inclusive of Accounting, Finance, Economics, MIS, etc.

Substitutions

  • None

Preferred

  • None

EXPERIENCE

Required

  • 5 years in a management role in Health Care Administration
  • 3 years with Medicaid Managed Care Benefits & Programs

Preferred

  • 10 years in management role in a related field
  • 7 years in the Healthcare Industry
  • 5 years with Applied Medical Economics/Cost Management
  • 3 years with Business Management Information Systems
  • 3 years with Data Analytics and Warehousing
  • 3 years with Project Portfolio, Program and Project Management
  • 3 years with Quality and Process Improvement 
  • 3 years of Vendor Management

LICENSES or CERTIFICATIONS

Required

  • None

Preferred

  • None

SKILLS (any of the following)

  • Six Sigma Green Belt or better
  • Project Management Institute Certification or equivalent
  • Business Process Management Institute Certification or equivalent

Languages (Other than English)

None

Travel Required

0% - 25%

PHYSICAL, MENTAL AND WORKING CONDITIONS

Position Type

Office Based

Teaches/trains others regularly
Frequently

Travel regularly from the office to various work sites or from site-to-site
Occasionally

Works primarily out-of-the office selling products/services (sales employees)
Does Not Apply

Physical work site required
Yes

Lifting: up to 10 pounds
Constantly

Lifting: 10 to 25 pounds
Rarely

Lifting: 25 to 50 pounds
Rarely

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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