Company :Highmark Inc.
Job Description :
This job serves as the primary lead in identifying, analyzing, designing, supporting the implementation, and ensuring appropriate performance evaluation of strategic provider partnerships. Includes setting priorities by identifying market needs, analyzing and developing partnership models and engaging providers in contracting discussions.
As part of the role, the incumbent should be able to set strategic direction, lay out a clear implementation plan for execution, be responsible for providing direction to their team, collaborate across the business to align other business owner’s efforts, and supporting market-facing activities.
- Lead an effort to complete a clear, detailed market analysis of each segmented market as it relates to the company’s need to develop relationships with local hospitals and physicians. Work closely with informatics and data analysis teams to determine specific needs including gaps in accessibility, areas of high cost care, and regions where community hospitals need further support. Set goals for each region based on these analyses.
- Support internal teams to validate the market analysis and design an enterprise wide Regional Strategic Provider Plan (RSPP) for each target region. Each plan will include the “needs” analysis and the detailed future strategy, choosing appropriate alternative reimbursement tools, to align with Organization’s overall strategy.
- Direct and manage activities to implement RSPP for each region, where relevant.
- Construct a tailored “bundled offering” of solutions to drive value for that market
- Work with key provider groups and hospitals to gain buy in and “sell” strategic initiatives for the purposes of piloting and implementing alternative care/reimbursement models
- Obtain feedback on these strategic initiatives. Work to gain consensus and incorporate necessary plan modifications.
- Lead, direct and support provider contracting as it relates to RSPP.
- Support direct in-market contracting discussions, including the execution of the various alternative reimbursement methodologies through the physician and hospital contracts with the company. This includes the implementation of bundled payments, implementation of episodic performance programs, gain-sharing, and other alternative re-imbursement methodologies.
- Ensure that equitable rates are negotiated for all providers and that unique provider agreements are implemented in a way that reflect our integrated delivery and financing models.
- Identify new, creative and innovative ways to structure health-care financing.
Manage strategic provider partnership focused provider relations staff in all aspects including:
- Provide clear direction regarding the execution of each RSPP and each contract.
- Support staff in their day to day interactions with the provider community in order to build and maintain strong relationships in the markets.
- Hold provider representatives and all team members accountable for specific targets and goals as it relates the strategy for each region.
- Manage personnel annual goals and annual review process.
- Handle all hiring and performance management plans.
Partner with finance and actuary to measure the impact and outcomes of different strategic partnerships, and modify approaches accordingly.
Inform the market for new models through maintenance of critical provider relationships, presentations at high impact events and conferences, continuous education to the provider community of the company’s approach and models, etc.
Other duties as assigned or requested.
- Bachelor’s Degree in Business or Health Administration or other related area
- 7 years' of healthcare provider delivery system or healthcare insurance experience
- 5 years' of management experience, with direct experience working with provider-related contracting and partnership models
- Master’s Degree
- Previous knowledge of informatics and data analytics
- In depth understanding of the Organization’s provider community, particularly in Western PA
- Knowledge of reimbursement methodologies and models
- Global understanding of care delivery models and provider alignment, across both payor and provider
- Experience interacting with providers in the market (negotiating/contracting experience)
- Ability to work effectively across functions and with the senior executive leadership team
- Strong analytical and interpersonal skills
- Presentation skills and a proven ability to communicate detailed information to healthcare executives and physicians
- Reimbursement, financial and analytical modeling
- Strong project management skills including the ability to manage multiple projects and meet concurrent deadlines
SCOPE OF RESPONSIBILITY
Does this role supervise/manage other employees?
Is Travel Required?
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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