Job Description :
This job is a key member of the Helion Network Performance Operations team, taking on a significant role for complex operational aspects of network design/development and value-based reimbursement programs. This includes evaluating networks and contract structures relative to current and proposed future state through the lens of the overall Helion post-acute network strategy, and making recommendations based on an understanding of that strategy. This job coordinates with multiple teams within Helion and develops comprehensive provider contracting strategies that incorporate incentives for performance and align to the goals of the business. This job will be responsible to oversee the operations and maintenance of reimbursement and other programs.
ESSENTIAL RESPONSIBILITIES (Describes the critical tasks, duties and responsibilities of the position.)
Works across matrixed organization to engage stakeholders and develop strategies that meet the goals of the organization. Responsible for operationalizing and maintaining reimbursement and network programs.
- Works across matrixed organization to engage stakeholders and develop strategies that meet the goals of the organization. Responsible for operationalizing and maintaining reimbursement and network programs.
Plans, organizes, and directs the day-to-day operations of the team; develops and implements policies and programs as necessary
Strategy Execution: Implements and executes the function's strategy to narrow the provider network and focus on top-tier partners. Promotes innovative, risk-based contracting with providers to incentivize delivery and outcome improvement, and meet corporate financial objectives. Supports the maintenance of the provider network in defined territories and within the post-acute space. Helps support provider contract negotiations with customer groups as needed.
Develop reimbursement strategies and tactics to mature PAC markets to risk over time in ways that align to health plan value-based reimbursement strategies. Execute the strategic plan by working collaboratively with other business areas throughout the organization to implement such strategies and tactics, including championing systems enhancements to support innovation.
Leadership Support: Supports policy and procedure development of team and programs. Insurer's alignment to network performance strategies and goals. Drives improvement initiatives established by leadership. Supports provider relations efforts as needed.
Provide direction, guidance, and training to teammates with less experience.
Service as project manager, assigning complex work and monitoring the accuracy and progress of assigned work.
Other duties as assigned or requested
Bachelor's Degree- Business, Healthcare Administration or other related area.
Substitutions (Acceptable substitutions in lieu of a degree 1 ½ years’ experience = 1 year college)
Minimum: This section refers to the minimum years and type of applicable experience needed to perform the job. Minimum requirements must be non-comparative, objective, and relevant.
8 years' experience in healthcare and health plan payor management required
In-depth knowledge/experience of healthcare and PAC-related financial implication
Preferred: This section refers to additional desired years and type of experience that the hiring manager would prefer, above and beyond the basic requirements of the job.
KNOWLEDGE, SKILLS & ABILITIES ( List the attributes required to perform the job through demonstrated service, education or training)
Proficient in MS Office products, specifically, Microsoft Excel, Word and PowerPoint
Excellent written and verbal communication skills; ability to communicate effectively both individually and in groups.
Broad experience in PAC price drivers and contracting methods
Proficient in operational and process-oriented solutions
Knowledge of national and regional healthcare industry trends and challenges
REQUIRED LICENSURE (Licenses that are required to perform the job)
TRAVEL REQUIREMENT: 25% - 50%
(List % of time traveling)
LANGUAGE REQUIREMENT ( other than English )?
(List primary language)
PHYSICAL, MENTAL DEMANDS AND WORKING CONDITIONS
( The physical, mental demands and working conditions described here are representative of those that must be met by an employee to successfully perform the essential function of their job. Reasonable accommodations will be made when necessary to enable individuals with disabilities to perform the essential duties of the position, to the extent that they do not cause undue hardship.
An employee in this position works in an office environment. The position frequently requires the employee to communicate effectively with others both inside and outside the workplace (e.g., in person, via telephone, via email). The employee must be able to understand, interpret and analyze data, solve problems, concentrate, and research, use available technological resources and systems (e.g., computers and computer programs), multi-task, prioritize, and meet multiple deadlines to complete essential tasks. The employee generally works in a fast-paced and frequently stressful environment, must attend work on a regular and reliable basis as well as adhere to all workplace policies, and may be called upon to work outside regular business hours.
Teaches/Trains others regularly Occasionally
Travels regularly from the office to various work sites or from site-to-site Does Not Apply
Works primarily out-of-the office selling products/services (Sales employees) Does Not Apply
Physical Work Site Required No
most On-The-Road Positions
An employee in this position may work in a home or company office environment but is also frequently driving to and from various locations to perform the work off-site. The position frequently requires the employee to communicate effectively with others both inside and outside the workplace (e.g., in person, via telephone, via email). The employee must be able to understand, interpret and analyze data, solve problems, concentrate, and research, use available technological resources and systems (e.g., computers and computer programs), multi-task, prioritize, and meet multiple deadlines to complete essential tasks. The employee generally works in a fast-paced and frequently stressful environment, must attend work on a regular and reliable basis as well as adhere to all workplace policies, and may be called upon to work outside regular business hours.
An employee in this position is frequently required to move throughout the workplace, sit, stand and walk, use hands and fingers to hold objects, tools or controls, possess fine motor skills (e.g., to write and operate a computer or to steer transportation equipment), possess gross motor skills (e.g., to carry items), reach with hands and arms, climb stairs and ladders, balance, stoop, kneel crouch and crawl, communicate effectively, and talk and hear. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus. The employee must be able to work in a busy environment where decisions often must be made quickly, must attend work on a regular and reliable basis, must adhere to all workplace policies, and may be called upon to work outside regular business hours. This work occurs in a [example: warehouse, hospital or provider’s office or mailroom].
Lifting: up to 10 pounds Occasionally
Lifting: 10 to 25 pounds Rarely
Lifting: 25 to 50 pounds
Does Not Apply
Changes Approved By:
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 position 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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