Company :Highmark Inc.
Job Description :
This job reports to the Vice President, Clinical Client Relations (CCR), and is primarily responsible for influencing the acquisition of new accounts and the retention of existing accounts through clinical direction. The incumbent develops and delivers Client-specific health management strategies that align with and promote the Organization’s clinical capabilities across the care management continuum. Presents customized clinical direction to Clients, based on their specific risk profile, and facilitates interventions that optimize the health status of employee populations with significant clinical and financial results. The incumbent facilitates other projects to strengthen the clinical expertise of CCR.
- Provide and interpret Client-specific clinical data to facilitate optimal interventions and significant clinical and financial results.
- Analyze clinical data to help Clients use such data to take action.
- Work with Sales and CCR staff to develop Client-specific health management strategies, i.e., action plans that address Client-specific clinical and financial risk, and justify investments in behavior change interventions.
- Work with Sales and CCR staff to provide medical expertise in presentation to Clients and prospects.
- Provide Clients with analyses and recommendations that address the present and future health status of their enrolled members, including high cost claimants and dependents.
- Use Alineo to keep abreast of the status of high cost claimants, and knows these cases; possesses intelligence around the drivers and trends.
- Provide Clients with recommendations that will impact medical cost trends.
- Contribute to the development of new reports that simplify complex data sets.
- Provide effective presentations to Clients and prospects on the Organizations clinical capabilities across the care management continuum.
- Communicate the Organization’s clinical value proposition, based on clinical capabilities, Client data, clinical value of products, pay for value care strategies, BCBSA capabilities such as Blue Distinction Centers and other BCBSA initiatives.
- Provide a deeper level of analysis as needed.
- Play a key role in the training of new medical directors by modeling the position internally and externally. (Examples: prep sessions with Sales, annual clinical review meetings with regional and national Clients, and meetings with Benefits Consultants.) In these situations, the Sr. Medical Director arranges for the new medical director to shadow the Sr. Medical Director, and then provides coaching and role playing on the topics discussed.
- Communicate post-presentation follow-up work with CCR clinical consultants and ensure that appropriate entries are made in the Sales Force Automation system to complete required communication and follow-up work.
- Provide clinical direction and clinical capabilities presentations for the largest and highest profile clients, such as business-critical prospects, government entities, Partner Plans, and large blocks of business.
- Develop, maintain, and document strong working relationships with Clients, consultants and other stakeholders in order to provide dedicated support and add value to the account relationship through clinical analysis, education, and presence.
- Demonstrate an understanding of Client industries.
- Document progress of relationships and contact with Client representatives in weekly reports and Sales Force Automation.
- Proactively reach out to Client contacts, outside of the meeting structure, at least 3x per year.
- Influence consultants’ and brokers’ recommendations to Clients and prospects based on the Organization's clinical capabilities and performance, and a deep level of analysis as needed.
- Work collaboratively with various internal and external leaders to optimize the functions of CCR and ensure that an account's specific clinical data will drive the right interventions for the right members. This is accomplished through the use of various Sales, Healthcare Informatics and Information Systems technical reports, and input from other Organization departments and consultants.
- Communicate effectively by providing both written information and verbal presentations in servicing accounts, as well as contributing to various interdepartmental projects.
- Provide expert support, as needed, to various internal entities through project facilitation, conducting meetings, attending client prep meetings, and other contributions of clinical expertise.
- Submit weekly reports, on the governance form provided, that highlight significant accomplishments, exceptions from the norm, barriers to progress, and additional interactions with Clients and consultants to strengthen relationships.
- Contribute to the CCR knowledge base, shares information from the knowledge base, and presents from the CCR knowledge base internally and externally.
- Learn from Sales Force Automation current products, the product roadmap, and how the Organization’s capabilities compete against other products and competitors.
- Understand the current regional and national health care environment and the Organization’s position on health care issues.
- Understand and applies privacy regulations. This position requires business savvy, flexibility, tact, and the ability to build internal and external relationships.
- Demonstrate support for the innovation and change needed to improve effectiveness.
- Honor and promote CCR’s Guiding Principles.
- Contribute to and utilize the Health Architect App demonstrate population risk, prevalence, cost, and to collaborate on strategies with Clients.
- Other duties as assigned or requested.
- A Medical (MD or DO) degree
- 5 years of prior clinical leadership experience in health care management
- Master's degree in business or a related discipline
- 5 years of healthcare management experience
- 2 years’ experience working in a health plan
- Prior account management support experience.
- Prior sales experience
- Experience with formal presentations to diverse audiences
- Experience with complex data analysis in addressing client issues
- Relevant licenses, certifications, training, etc.
- Current, unrestricted PA medical license
- Board certification in an ABMS medical specialty
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.
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