Company :Highmark Health
Job Description :
This job researches, recommends and manages a portfolio of provider performance improvement measures (both quality and cost based) across the Organization's value based reimbursement programs and strategic provider initiatives. The incumbent is responsible for working through the operational implementation of value-based performance measurement and will work closely with matrixed partners across the organization and will lead and support multi-disciplinary teams of professionals within the organization to implement transformational, provider-focused strategies which are created to improve provider practice-patterns which contribute to maximized health outcomes of the Organization's members and health plan care cost savings.
- Serve as internal project lead to ensure alignment and consistency in the Organization's value based performance measurement portfolio across all value based reimbursement programs and strategic provider initiatives.
- Conduct sponsor meetings, define the project scope (including HEDIS measures, Clinical Quality Feedback loop), objectives and requirements; develop, maintain and monitor project scope, plans and deliverables including schedule controls (calendars), requirements documentations, program materials, issue management, system defects and test plans.
- Maintains requirements documentations, program materials, issue management, system defects and test plans for all incumbent's programs.
- Communicate project information/status to all levels and/or management for assigned programs, customer and project team; and provide feedback to direct-line management regarding performance and presents project deliverables to appropriate audiences.
- Act as SME to internal partners (Sales, Product, Network, Contracting) as it relates to various Quality and Value Based Reimbursement Initiatives.
- Continuously examines processes and procedures to identify opportunities for improvement and refinement.
- Complete all other Quality Improvement Program Management activities.
- Develop and maintain positive customer (internal and external) and team relationships.
- Delivers presentations of project status to effectively communicate throughout the project life-cycle and keep stakeholders informed of changes in performance measurement metrics impacting programs or strategic provider initiatives.
- Serve as operational interface to business areas on behalf of market transformation division.
- Work with professional teams and first and second line management teams when partnering on value-based reimbursement program implementation and other strategic provider initiatives.
- Serve as Highmark liaison for BCDSA updates regarding Quality and Measurements.
- Other duties as assigned or requested.
- Bachelor's Degree in Business, Healthcare Administration or Healthcare-related field
- Master's Degree in a Healthcare-related field
- 5 years of relevant, progressive experience in a hospital or healthcare related field
- 5 years of managing facility or professional quality improvement programs
- 5 years with clinical quality measure sets (STARS, HEDIS, etc)
- 7 years of experience managing large complex projects and/or programs
- 3 years working with clinical quality/efficiency provider performance measure, process improvement (Six Sigma, Lean, TQI, PDSA) concepts and consultative techniques.
- 3 years working with advanced healthcare reimbursement models (pay for value, value based reimbursement, capitation, etc.)
- 1 year of project management experience or equivalent training
LICENSES or CERTIFICATIONS
Preferred (any of the following)
- Registered Nurse (RN)
- Certified Coding Associate (CCA) or Certified Coding Specialist (CCS)
- Certified Professional in Healthcare Quality (CPHQ)
- Inter-personal and relationship management skills, presentation skills, facilitation and negotiation skills, communication skills (written and verbal)
- End-user computer skills (e.g., word processing, tables and graphics, spreadsheets, presentations and templates)
- Problem solving and adaptability to a dynamic work environment
- Ability to work well independently and as part of a team
- Functional operating knowledge of the healthcare industry including but not limited to national/state regulatory environment and healthcare policy, public health policy, third party quality organizations and standards, guidelines or policies
Language Requirement (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 position 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.
Pay Range Minimum:$67,500.00
Pay Range Maximum:$124,800.00
Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
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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