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J209464

Senior Director Provider Contracting

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 oversees all contracting activity for Gateway Health plan, including: Federally Qualified Health Center (FQHC) contracting, Hospital Contracting, Provider Contracting, Ancillary Contracting, and Provider Relations.  It is the responsibility of this role to control cost, improve quality, secure appropriate access to services,and create a better member experience.  The incumbent leads a team to set and execute contracting strategies to achieve and maintain a competitive position for the Organization’s products.  The incumbent is responsible for integrating provider contracting strategies with clinical management, product development, and consumerism strategies.  The incumbent will have the latitude to create innovative reimbursement models to meet their strategic goals.
 

ESSENTIAL RESPONSIBILITIES

  • 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.
  • Develop, design, and implement, in collaboration with key internal departments of Strategy, Finance and Health Plans and Implementation, methodologies aimed at controlling health care costs while balancing the need for accessible and available provider networks.  Work with the appropriate internal departments to develop appropriate contract and reimbursement language.  Design, as necessary, and utilize financial analysis and medical informatics to determine appropriate reimbursement rates and methods.
  • Act as an integrator across multiple business units in multiple States to align strategies, maximize value, and streamline processes.Negotiate pricing and service terms, including performance-based reimbursement models, to meet strategic goals.
  • Create a culture of process improvement through appropriate monitoring and impact assessment. Ensure that all contractual Service Level Agreements and geoaccess requirments are being met and that networks are sufficient to meet both the needs of existing lines of business as well as and ensuring that expansion market needs are met.  
  • Provide strategic direction and guidance on all provider negotiations, taking primary responsibility for complex and strategic negotiations, as applicable.
  • Working in concert with Provider Network leadership, provide strategic direction, guidance, and oversight to all relationships with providers to ensure high level of satisfaction with operations and to ensure that all necessary training and educational needs are communicated.
  • As an organization leader and subject matter expert, provide thoughtful and engaged leadership both within  direct area of responsibility,  across the organization and with external entities.
  • Other duties as assigned.

EDUCATION

Required

  • Bachelor's Degree in Business Management

Substitutions

  • None

Preferred

  • Master's Degree in Business Management

EXPERIENCE

Required

  • 7 - 10 years of Leadership Experience
  • 5 - 7 years of Provider Contracting Experience
  • 3 - 5 years of Sourcing Experience

LICENSES OR CERTIFICATIONS

Required

  • None

Preferred

  • None

SKILLS

  • Collaborative Problem Solving
  • Contract Negotiation
  • Team Leadership
  • Influence and Persuasion
  • Critical Thinking
  • Strategic Thinking
  • Outstanding Interpersonal Communication Skills

Language Requirement (other than English)

None


Travel Required

25% - 50%

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

Frequently

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

Rarely

Physical work site required 

Yes

Lifting: up to 10 pounds

Frequently

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

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.

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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