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J211470

Director Market Medical Cost Strategy- Sign on Bonus!

Highmark Inc.

  • Company Highmark
  • Home, PA
  • Finance
  • Full time
  • Day (United States of America)

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 )

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.

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

California Consumer Privacy Act Employees, Contractors, and Applicants Notice


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