Company :
Highmark Inc.Job Description :
JOB SUMMARY
This job supports our strategic vision of affordability and quality for our members. Adhering to our Customer First core behaviors, this role gathers specific needs and insights of of a market population, and works with matrixed partners to drive affordable high quality solutions to ultimately lower the cost of care and improve the overall quality of care.
ESSENTIAL RESPONSIBILITIES
- Perform management responsibilities to include, 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.
- Directly manages the C2V strategy team. Areas of responsibility include medical spend ideation process and workshops, dependency tracking and mitigation, stakeholder communications, risk mitigation, governance management, and leadership initiative packaging/communications.
- Partners with product and actuary teams to gather and prioritize product level economic insights specific to medical spend.
- Partners with Medical Economics team to identify segment/region/product level of medical cost targets. Strategically understanding and aligning these trends to our market pricing targets are critical for success.
- Participates in Medical Trend Committee to have a strong understanding of Medical Spend opportunities by product that can be leveraged for ideation and further analytic refinement.
- Collaborates with Clinical Analytics to align medical trend opportunities to population health epidemiology in an effort to identify specific cohorts of member need that directly feeds the current and future clinical solutions.
- Inventories product level delivery milestone dates such as CMS Bid Cycle, RFP's, etc. and aligns solution delivery timelines.
- Partners with strategic providers and Highmark provider supporting teams to strategically integrate medical spend solutions form both Payer and Provider in a clinical ecosystem that promotes affordability, quality, and patient experience.
- Partners with matrixed clinical partners to prioritize new medical spend solutions and drives implementation teams to align to product level medical economic financial forecasts/budgets.
- Other duties as assigned or requested.
EDUCATION
Required
- Bachelor's Degree in Healthcare, Business, Finance or Clinical Operations
Substitutions
- 6 years of related and progressive experience in lieu of Bachelor's degree
Preferred
- Master's Degree in Finance or Business
EXPERIENCE
Required
- 7 years in the Healthcare Industry
- 7 years in Medical Cost Management
- 5 years in a management and/or leadership role
Preferred
- None
LICENSES or CERTIFICATIONS
Required
- None
Preferred
- None
SKILLS
- Influence and Persuasion
- Collaborative Problem Solving
- Leading Change
- Conflict Management
- Written & Oral Presentation Skills
- Business Transformation
- Developing People
- Delegation
- Process Improvement
- Stakeholder Management
Language (Other than English):
None
Travel Requirement:
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
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
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 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.
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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