Job Description :
This job coordinates with the Health Plan to ensure home care service's (HCS’s) clinical pathways and protocols are in compliance with other plans and applicable regulations. This job will also focus on developing the guidelines required to measure evidence based outcomes, and to drive sound clinical practice guidelines and recommendations that align to the needs of the payer organization.
- Drive Strategic Initiatives: Coordinate with the Health Plan to ensure clinical pathways/protocols are in compliance and alignment with HCS and customer initiatives.
- Drive Strategic Initiatives: Develop the strategy for identifying the specific clinical programs that will coordinate with customer health programs as needed. Develop the strategy for determining which patients are in need of clinical support, how those patients will be targeted accordingly, and what treatment approach is most appropriate.
- Drive Strategic Initiatives: Identify where patients are geographically, formalize the process for identifying them accordingly, and understand/articulate the best-fit options for providing HCS solutions and pathways to care.
- Drive Strategic Initiatives: Work closely with the the network management function to optimize how the best clinical home health practices can be accounted for and aligned to key contracting initiatives and development to help improve clinical outcomes. Articulate the benefits of clinical adoption and advise on best practices and alignment to HCS services.
- Drive Strategic Initiatives: Analyze and interpret data to drive clinical adoption and client satisfaction.
- Customer Management: Develop and socialize strategy for engaging key partners in the community that can support the model from a clinical standpoint by bringing a clinical background to key customer initiatives to ensure the appropriate perspective regarding care pathways is represented.
- Customer Management: Interface with customer executives (COO, CMO, etc.) to help them understand and support the model from a clinical standpoint and promote HCS services through demonstrations, evaluations, and/or site visits (as needed).
- Customer Management: Develop a strategy to determine and drive ongoing client satisfaction, retention and testimonials that will resonate with the target customer. Capitalize on relationship opportunities to ensure the model and applicable services are being represented in the market.
- Customer Management: Analyze region for revenue opportunities and coordinate with leadership to ensure representation in business and strategic planning.
- Other duties as assigned or requested.
- Bachelor's Degree- Nursing, Medicine, Science or related discipline
- 5 years' experience in a clinical environment
- 2 years' experience as a clinical leader
- 4 years' experience leading/managing teams
- Experience facilitating organizational change and strategic clinical alignment to business functions goals/values
KNOWLEDGE, SKILLS & ABILITIES
- Knowledge of medical institution hierarchy
25% - 50%
PHYSICAL, MENTAL DEMANDS AND WORKING CONDITIONS
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
Travels regularly from the office to various work sites or from site-to-site Does
Works primarily out-of-the office selling products/services (Sales employees)
Does Not Apply
Physical Work Site Required
Lifting: up to 10 pounds
Does Not Apply
Lifting: 10 to 25 pounds
Does Not Apply
Lifting: 25 to 50 pounds
Does Not Apply
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.
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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