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J207051

Manager Value-based Reimbursement, Strategy & Innovation (Remote)

Highmark Wholecare

  • Company April 2022 Ed (1)
  • Home, PA
  • Provider Services
  • Full time
  • Day (United States of America)

Company :

Highmark Wholecare

Job Description : 

JOB SUMMARY

This job is responsible for all innovation and design related to the Organization's advanced value-based programs, which encompass risk-based programs and custom reimbursement designs. The incumbent supports and drives the overarching strategy and operationalization of the health plan's most advanced models. Manages a team and the ideation of new reimbursement methodologies and how they interlace into broader health plan and enterprise strategies and on-going initiatives. 

ESSENTIAL RESPONSIBILITIES

  • Perform management responsibilities including, but are 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.
  • Work with actuarial and operations departments to develop and design value based programs across the continuum of care for the various Organization markets as well as reevaluate existing programs on annual or as needed basis
  • Work with reimbursement, actuarial and analytic departments to ensure that operational capabilities are built in line with the strategic roadmap to ensure maximum flexibility and speed to market
  • Assist on all current and future partnerships with Provider Partnerships, Operations, and other internal and external stakeholders as needed to bring programs from conception to deployment.
  • Support the Enterprise on issues related to value-based reimbursement, including impact to organizational strategic efforts or new programs in development.
  • Build and maintain collaborative relationships at all levels to ensure VBR vision aligns and integrates into the Enterprise's strategic direction.
  • Lead innovation workgroups with AHN, internal stakeholders, and external stakeholders to create new, innovative reimbursement designs to produce overall total cost of care savings. These work groups should also interlace business partners from Product, Network, and Clinical Services to create robust, all-encompassing strategies. 
  • Other duties as assigned

EDUCATION

Required

  • Bachelor's Degree in Health Administration, Business Administration/Management, Public Health, Healthcare Informatics or Pre-Medicine

Substitutions

  • None

Preferred

  • Master's Degree in Business Administration/Management, Public Health, Health Administration or Healthcare Informatics

EXPERIENCE

Required

  • 5 - 7 years in the Health Insurance Industry

Preferred

  • 1 - 3 years in Actuarial
  • 1 - 3 years in Clinical Services

LICENSES AND CERTIFICATIONS

Required

  • None

Preferred

  • Lean Six Sigma

SKILLS

  • Consulting
  • Health Insurance
  • CMS Regulations
  • Healthcare Management
  • Actuarial
  • Strategic Planning
  • Public Health

Language (Other than English)

None 

Travel Required

0%  - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-Based

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Occasionally

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required 

Yes

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 job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

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

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )

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For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

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