Company :Highmark Inc.
Job Description :
This job serves as a senior executive representative of the Organization to the provider community. Accountable for deploying the Organization’s provider relationship and contract strategy and deploying Highmark’s health plan and provider capabilities across relevant functions (product, VBR, analytics, clinical transformation, etc.) into the market through provider relationships that drive value to the communities served. The incumbent plays a highly visible market-facing role, and must build deep relationships with providers and other relevant stakeholders (e.g., customers, brokers, regulators, etc.). Responsible to build strong, cross-enterprise relationships, and collaborate with leaders across Product and Healthcare Services and other Health Plan functions (e.g., Segment Leaders, Finance, HPO, etc.), and Enterprise functions (e.g., Strategy, Corporate Development, etc.). Critical to this role will be building a strong team, focused on the future strategy of the organization.
- Provide the strategic leadership for provider contracting, and provider relations & engagement strategies across the enterprise.
- Define, develop, and deploy a roadmap of new solutions to support provider transformation in the market. Work with cross-functional stakeholders to align and execute the build and deployment of these strategies. This could include: New product constructs; High performing network constructs; Advanced analytic and population health solutions; Practice transformation; Clinical transformation and clinical care model deployment.
- Ensure best-in-class unit cost contracting trends, while the transition to value-based reimbursement progresses, along with appropriate contract terms that meet business and regulatory requirements.
- Build a high performing team, with strong talent, aligned vision, purpose-driven mindset, and willingness to drive transformation.
- Perform management responsibilities to include, but are not limited to: Hiring and termination decisions; Coaching and development; Rewards and recognition; Performance management and staff productivity.
- Ensures that equitable rates are negotiated for all providers and that provider agreements are in place that appropriately reflect the relationship between the company and control health care costs.
- Provides executive direction for all professional, ancillary and facility provider relations within the market.
- Ensures department is prepared to serve the provider community.
- Provides input and leadership for the design and implementation of strategic reimbursement, relations and strategic collaboration related activities.
- Provides executive direction and oversight of provider contracting and relations in the market service area
- Ensures facility provider contracts and professional providers in market area are managed effectively and efficiently, and meet regulatory requirements.
- Other duties as assigned or requested.
- Bachelors’ degree
- Master's Degree in Business Administration or Public Administration
- 7 years of experience in health care administration/financing/delivery or a related field
- 7 years in a management role
LICENSES or CERTIFICATIONS
- Certified Public Accountant (CPA)
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.
Pay Range Minimum:$170,000.00
Pay Range Maximum:$322,900.00
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.
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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