Job Description :
This job serves as the senior executive representative of the Organization to the provider community. S/he is accountable for defining the Organization’s provider partnership and contract strategy, deploying Highmark’s health plan and provider capabilities across relevant functions (product, VBR, analytics, clinical transformation, etc.) into the market through partnerships that drive value, managing provider relations, and driving best-in-class contracting strategies. 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.). S/he will also need to build strong, cross-enterprise relationships, and collaborate with leaders across Product and Healthcare Services, Allegheny Health Network, 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 partnership, contracting, and provider relations and engagement strategies across the enterprise, to ensure Highmark is driving outcomes and meeting the needs of both the health plan and providers.
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.
- Drive the design and implementation of strategic partnerships with key providers and health systems that deliver shared value, improve costs, quality, and patient experience, and support the transition to value-based care delivery.
- 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. Meet the appropriate service requirements of providers.
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;
- Directing staff on the day-to-day operations of the department.
- Other duties as assigned.
- Bachelor’s Degree in Business or Health-related field
- Master’s or other Advanced Degree
- 10+ years of experience in health care administration/financing/health care delivery or a related field
- 10+ years of management experience
- 5 years of contracting or sales experience
- Strong external market and internal stakeholder relationship management
- Ability to quickly understand and learn local market dynamics
- Strong transformational leadership skills; highly collaborative
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
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.
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