Company :Highmark Health
Job Description :
This job works closely with management, and assists in developing new reimbursement models for the Organization's strategic partners and initiatives. The incumbent influences VBR integration into the overall Enterprise strategy through collaboration with Senior-level internal/external stakeholders. Ensures a high degree of development, efficiency, and effectiveness on the support and deployment of all VBR Design models.
- Support and lead, as needed, the development and completion of sales cycle (from model conception to implementation) of VBR programs for key strategic accounts and/or initiatives. Support strategic provider relationships to understand the current health care delivery state, readiness for change, test value based programming concepts and components, identify key partners, identify and proactively communicate market transformation concepts with provider and professional advocacy societies and key thought leaders.
- Ensure integration with Enterprise/PNR strategic direction. Collaborate with PNR stakeholders to incorporate VBR into product, network, and provider integration. Liaison with Enterprise & P&L leaders on their overarching strategies to ensure broader alignment of VBR approach. Develop targeted reimbursement models that support enterprise strategic initiatives that might fall outside of planned value-based reimbursement designs and/or to serve as a focus of innovation.
- Build collaborative relationships within the organization, external local, regional and national healthcare industry leadership to both inform market transformation strategies as well as to externally advance the organization's vision for care delivery transformation. Relationships will include internal areas of the enterprise such as the strategic, financial, and clinical leadership of the enterprise, in addition to the multiple areas of health plan.
- Support development of the overall conceptualization, strategy alignment, and high-level design of new value-based reimbursement models for PCPs, specialists, and health systems across the Organization's footprint, based on deep understanding and knowledge of trends in other areas of the country with both government and private payers. Programs will include but not be limited to pay-for-value programs, episode payments, prospective bundled payments, gain share and risk share models and will be implemented for the Organization's Medicare Advantage, Medicaid, ACA, and commercial populations with the goal of maximizing quality while reducing healthcare costs.
- Work with reimbursement, actuary, and analytic departments to ensure that operational capabilities are built in line with the strategic roadmap to ensure maximum flexibility and speed to market.
- Serve as a subject matter expert working in concert with provider relations and clinical transformation consultants to explain new programs and results to key provider partners.
- Collaborate with and support the senior Strategic Partners Consultant role as needed
- Other duties as assigned or requested.
- Bachelor's Degree in Public Health, Health Administration, Economics, Mathematics, Engineering, Marketing, Business Communications or related field
- 6 years of related and progressive experience in lieu of Bachelor's degree
- Master's Degree in Public Health, Health Administration, Economics, Mathematics, Engineering, Marketing, Business Communications or related field
5 years in the Health Insurance industry, Healthcare industry and relationship management
- 5 years of Consulting
- 1 year in a Provider facing role
- 1 year with Provider payment/reimbursement
- 1 year with strategic planning/corporate development
LICENSES AND CERTIFICATIONS
- Analysis of business problems/needs
- Oral & Written Communication Skills
- Problem Solving & Decision Making
- Project Management
- Strategic Partnerships
- Strategic Relationship Building
- Strategic Thinking
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.
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.
EEO is The Law
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