Company :Highmark Inc.
Job Description :
This job contributes to the success of the Organization's population health strategy and the department's goals and initiatives by focusing on the health and well being of members across the health continuum in all lines of business. The incumbent participates in the development of the department's strategy and ultimately owns the implementation of that strategy for the areas of nurse support for inbound navigation calls and care coordination outreach, Wellness, Social Work and Non-Clinical Support. Oversees the relevant clinical programs and processes and is responsible for continuous improvement of the programs, systems, processes, policies, vendors, and staffing necessary to ensure cost effective delivery of the acuities for the previously mentioned areas and the outcomes/member impact. The incumbent leads the development and execution of member-facing tools and interventions, and ensures attainment of client and/or market-specific operational, clinical and financial commitments, and performance guarantees. Increases levels of engagement in Clinical Care and Wellness programs and improving member/client satisfaction with the services. The incumbent is responsible for the performance of these initiatives; quantifying outcomes and bench-marking them to industry standards.
- Perform management responsibilities including, but not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
- Collaborate with leaders across the department and the Enterprise to provide strategic input and operational ideas for customer-focused initiatives that improve customer satisfaction, maximize efficencies, produce cost savings, or generate better health outcomes. Share insight and ideas specifically related to nurse support for care coordination, wellness, social work and non-clinical CMDM support and the potential impact on our members. Work to develop targets for outcomes and to measure progress.
- Monitor performance against new and existing programs including analyzing the financial return on investment and member outcomes.
- Partner with product, sales, and other areas across the Organization to ensure the availability of an industry competitive suite of product and service offerings. Identify competitive gaps in current programs, evaluate potential solutions, recommend and implement new capabilities. This may include vendor partners and working with Procurement and the internal vendor team on contract negotiations and vendor management.
- Other duties as assigned.
- Bachelor's Degree in Health related field
- 10 - 15 years of Clinical Services experience
- 3 - 5 years of Management experience
- 3 - 5 years of Compliance experience
LICENSES OR CERTIFICATIONS
- Registered Nurse
- Registered Dietitian
- LSW (Licensed Social Worker)
- Leading Change
- Analysis of business problems/needs
- General Computer Skills
- Financial Analysis
- Written & Oral Presentation Skills
- Healthcare Industry
PHYSICAL, MENTAL DEMANDS AND WORKING CONDITIONS
Teaches/Trains others regularly
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.
EEO is The Law
For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org