Company :Highmark Inc.
Job Description :
This job is responsible for designing and implementing individual components of the data driven clinical and health management strategy for Highmark clients. The Health Management Specialist brings population health expertise, strong project management skills, program execution and problem solving to customers engaged in a data driven, results-oriented health management strategy. The incumbent provides meaningful support to external stakeholders to assist them in the development and implementation of effective client/member clinical initiatives to optimize the engagement of members and outcomes for clients.
- Collaborate with Client and Clinical Strategy Consultant, Client Manager and Client to finalize action plans and timelines based on Clients’ comprehensive Clinical and Health Management Strategy. Communicate key advancements and/or the need for reevaluation of plans and timelines as needed.
- Acquire client specific details then execute custom design and implementation of programs and services including and not limited to clinical model and point solutions, reward programs, health challenges and communications. Remain current on clinically relevant population health management resources to impact medical trend.
- Work collaboratively within a team to demonstrate and share best practices and client successes. Proactively utilize services within Highmark to deliver and ensure a positive, differentiated customer and member experience. Support on-site events as appropriate.
- Consult with clients through the planning, implementation, and evaluation phases of a health management strategy. Support Client Initiatives that improve an organization’s culture of health.
- Educate client/member on program components to ensure information on solutions are understood and well communicated to employee population.
- Works independently to implement clinical strategies with clients and members. Utilizes clinical knowledge and critical thinking skills to collaborate with clients on clinical strategy.
- Works collaboratively with the Clinical Strategy Consultant to create and advance the clinical and health management strategy. Participate in workgroups and initiatives as needed to enhance clinical offerings and streamline implementation processes. Serve as day-to-day client contact to schedule and deliver reports, research issues, monitor participation/outcomes/discrepancies, and questions related to reports, programs and interventions. (I.e. Reward completion reports and aggregate snapshots, communication changes, etc.).
- Other duties as assigned or requested.
- Bachelor's Degree in Nursing, Nutrition, Exercise Science or Social Work
- Master's Degree in Business or a clinical field
- 3 years in a clinical, health or worksite health promotion setting including program planning, development , implementation and evaluation
- 1 year in the Health insurance industry and understanding of health insurance products
LICENSES or CERTIFICATIONS
- Registered Nurse (RN) OR
- Registered Dietitian (RD) OR
- Licensed Social Worker (LSW)
- Experience working in a highly matrixed and complex management structure
- Experience in health insurance field working with health plans
- Thorough understanding of population health management
- Ability to work collaboratively with the Clinical Strategy Consultants, clients and internal stakeholders
- Written and oral communication, analytical and inter-personal skills
- Strong member facing service skills
- Problem solving skills
- Conflict and crisis management skills
- Proactive and anticipatory approach to clinical client product implementation and inquiries
- High energy level
- Passion for the type of work described and sensitive to client needs
Language (Other than English):
25% - 50%
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.
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.
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