Company :Highmark Inc.
Job Description :
This job supports the acquisition of new accounts and retention of existing accounts by working directly with client managers within national and regional markets. The incumbent is primarily accountable for clinical analysis and preparation of reporting metric deliverables for Highmark customers, including healthcare consultants and brokers. The incumbent interprets client specific clinical data to assess clinical interventions that deliver clinical and financial results. They represent Clinical Strategy to maintain, improve and design reporting that meets the needs of the clients.
- Analyze client clinical data to determine trends and cost drivers that can be impacted by Highmark’s programs and services. Data set metrics include utilization and cost trends, prevalence and risk reporting, and aggregate population health management outcomes.
- Collaborate with Clinical Strategy Consultants, Health Management Strategy Consultants, Client Managers and other internal departments to prepare data analyses and deliverables that represent clinical management strategies and clinical capabilities to existing clients and potential clients.
- Develop and foster internal relationships across the organization and external vendor partners. Represent Clinical Strategy to maintain, improve and design reporting that demonstrate Highmark’s analytic insights, clinical capabilities, core/buy up product recommendations/outcomes and member engagement strategies.
- Research and stay current on health, wellness, productivity, risk and care management trends in the market place in order to share insights and best practices that should be illustrated in reporting/deliverables.
- Support Client Strategy Team and Client Managers for clinical related inquiries. Participate in internal workgroups as need, as subject matter experts.
- Responsible for identifying and completing a process improvement project at least annually in conjunction with Clinical Strategy leadership team. Assist by providing appropriate content and consultation to support the RFP/RFI process.
- Other duties as assigned or requested.
- Bachelor's Degree in Nursing or a clinical related field
- Master's Degree in Business or a clinical related field
- 5 years in a clinical or managed care setting
- 3 years of analyzing clinical outcome data
- 3 years of Project Management
- 1 year designing outcome reporting and proficiency in reporting tools
- 1 year in a business or clinical environment with direct responsibility for applying technology
LICENSES or CERTIFICATIONS
- Registered Nurse (RN)
- Critical thinking skills
- Understanding of key clinical concepts
- Strong proficiency in Microsoft Office, Cognos, Analytics Navigator and other similar databases
- Effective problem solving and decision making skills
- Effective written and verbal communication skills
- Strong business acumen
- Conflict and crisis management skills
Language (Other than English):
0% - 25%
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.
EEO is The Law
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