Company :Highmark Health
Job Description :
The SVP, Clinical Transformation Leader will be responsible for the strategic design and delivery of care including scaling condition-based solutions and appropriateness of care programs across our footprint and other provider partners. This job will serve as the clinical dyad to the provider transformation leader in delivering clinical practice transformation to optimize the way we practice. They will also be responsible for the clinically integrated network design and delivery and clinical service lines to include behavioral health, social determinants of health and pediatrics among others.
This incumbent is accountable for overseeing the clinical strategy of opportunity identification, design, readiness, implementation and adoption of the living health solutions and programs to reinvent health. The incumbent will be responsible for designing, in partnership with leaders across the enterprise, multi-year approaches to provider evolution focusing on a programmatic approach to system transformation that includes clinical and cultural drivers. Clinical practice transformation will include standardized practice patterns which will lead to both waste reduction, efficiencies, and improved health outcomes. One key area of focus for this role will be around driving and scaling solutions related to appropriateness of care . The incumbent will serve as the Physician lead for the overall program across the enterprise working closely with physician executive leads at the various provider partner organizations. They will provide clinical thought leadership to help identify high-impact opportunities to improve appropriateness of care where clinical variability results in suboptimal patient outcomes or unnecessary cost. The SVP will help identify the right provider engagement strategies to drive behavior change. They will design and help lead implementation of a physician-led continuous improvement process across our provider partners to improve performance against our Living Health solutions, changes in clinical practice patterns and appropriateness of care metrics.
The SVP, Clinical Transformation leader will be expected to effectuate successful practice transformation by working with physician executives across the Highmark footprint to integrate and coordinate the various programs within the Clinical Transformation strategy, including Product & Health Experience, Right Care, Virtual Health, Behavioral Health as well as Home & Community Care.
The SVP will partner with the Provider Transformation administrative lead on relationship discussions but will have the primary responsibility of managing all clinical decisions related to the integration of Living Health into the strategic planning process of the partner providers.
- Co-Lead the development and ongoing refresh of the Highmark Health strategy for provider transformation. That strategy will include a multi-year approach to transformation, inclusive of all system levers and capital funding considerations, market inputs and clinical service contributions, and where innovation will take place. All of this will be done in the context of the broader Living Health strategy while ensuring linkage to clinical analytics and finance.
- Be a resource to the Product and Health Experience team in the solution development process. Provide oversight of clinical solution delivery and clinical service lines (Behavioral Health, SDoH, Pediatrics).
- Co-lead the build-out and coordination of the delivery network needed to drive adoption of the portfolio of scaled solutions by our system partners and their clinicians.
- Represent the clinical point of view on relevant decisions related to the identification, build-out, and management of technology needed to support operational changes in line with overall objectives.
- Prioritize appropriateness of care opportunities submitted by other clinicians with analytics support from the administrative team. Ensure medical policy is aligned to the latest evidence-based guidelines for priority initiatives, providing the clinical voice and rationale for proposed changes. Lead external meetings with executive clinical leaders from strategic provider partner systems to scale these opportunities within their networks.
- Serve as an ambassador for Highmark Health and its strategy to partner clinical organizations in partnership with the SVP, Provider Transformation.
- Work in concert with Product and Health Experience team, Enterprise Clinical Organization leaders and physician leaders across the markets to monitor ongoing effectiveness of virtual solution delivery and their integration and adoption by the physician practices .
- Ensures collaboration and sense of urgency around clinical improvement and optimization.
- Performs management responsibilities to include but not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.
- Provide other duties as assigned.
- MD or DO
- Masters in business, medical management or equivalent degree.
- 10+ years of experience as a practicing physician
- Board Certified physician with a current, unrestricted medical license in any US State and the ability to obtain a PA medical license within the first 6 months of employment.
- Demonstrated record of clinical and executive physician leadership. Examples include but are not limited to experience leading multispecialty physician groups, health system or integrated delivery & finance system CMO or C-suite executive role,
- Track record of execution in a value based environment with accountability in capitated or risk sharing arrangements.
- Experience in leading clinical transformation programs
- Experience with virtual health delivery
- Experience and effectiveness working in a highly matrixed structure
- Demonstrated record of leading clinical change, preferably across disciplines/departments/institutes
- Strong networking capabilities and ability to lead through partnership and collaboration
- Capacity to execute both short-term wins and long-term strategies
- Strong verbal and written communication skills
- Ability to organize, prioritize, and accomplish multiple, complex tasks simultaneously
LICENSES or CERTIFICATIONS
- Licensed Physician
- Strong verbal and written communication skills, can visually convey concepts
- Managing through some levels of ambiguity. Ability to create a function “from scratch”
- Experience in matrix management, including own function and providing matrix oversight to others
- High degree of emotional intelligence
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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