Job Description :
This job is responsible for all innovation and design related Highmark Health’s advanced value-based programs, which encompass risk-based programs and custom reimbursement designs. The manager supports and drives the overarching strategy and operationalization of the health plan's most advanced and transformative models. This role will manages a team, the ideation of new payment methodologies, and how they interlace into broader health plan and enterprise strategies.
Employee Referral Payout: Level 2
- Strategically identify, design, test, and implement transformative payment and reimbursement approaches that foundationally improve the Quadruple Aim
- Lead a high performing team as a manager, coach, advocate, and resource; guide and support success of individual contributors
- Assist on all current and future partnerships with Provider Partnerships, Operations, and other internal and external stakeholders as needed to bring programs from conception to deployment
- Provide expertise and guidance to matrixed partners and team members across operations, quality, reimbursement, compliance, STARS and payment transformation to maximize outcomes
- Successfully partner with actuarial and operations departments to develop and design value based programs across the continuum of care; continually reevaluate, expand, and improve current initiatives and programs
- Work with reimbursement, actuarial and analytic departments to ensure that operational capabilities are built in line with the strategic roadmap to ensure maximum flexibility and speed to market; ensure governance and portfolio management of all alternative payment and value based models
- Support the Enterprise on issues related to value-based payment, including impact to organizational strategic efforts or new programs in development.
- Build and maintain collaborative relationships at all levels to ensure VBR vision aligns and integrates into the Enterprise's strategic direction
- Lead innovation workgroups with Allegheny Health Network,, internal stakeholders, and external stakeholders to create new, innovative reimbursement designs to produce overall total cost of care savings.
- Perform management responsibilities including, 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
- Bachelor's Degree in Health Administration, Business Administration/Management, Public Health, Healthcare Informatics or Pre-Medicine
- 5 – 7 years in the Health Insurance Industry
- Master's Degree in Business Administration/Management, Public Health, Health Administration or Healthcare Informatics
- 1 – 3 years in Health Insurance Industry, Consulting, or Clinical Services
LICENSES AND CERTIFICATIONS
- Health Insurance
- CMS Regulations
- Healthcare Management
- Strategic Planning
- Public Health
- Business Planning
- Financial Modeling
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
Does Not Apply
Lifting: 10 to 25 pounds
Does Not Apply
Lifting: 25 to 50 pounds
Does Not Apply
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.
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