Company :

Highmark Inc.

Job Description :

JOB SUMMARY

The job works directly with network providers to champion provider practice transformation in support of various Organization endorsed strategic care delivery models. Leads the day to day execution of projects, initiatives and significant work streams related to provider transformation and performance excellence in various health care delivery settings. The incumbent serves as the primary catalyst in identifying and facilitating change in the form of industry standard evidence-based best practice improvement opportunities that are required to accelerate the achievement of goals related to clinical operations excellence and optimal, sustained patient care (as manifested by patient outcomes).

ESSENTIAL RESPONSIBILITIES

• Provide hands on consultative and training services to assigned network providers and/or provider organizations including hospitals, primary care practices, specialty care practices, ancillary providers to facilitate and direct transformation activities geared towards meeting the goals of all required care delivery models. This is completed via baseline provider performance/practice analysis, gap assessment, team facilitation, transformation plan development, fostering of collaborative relationships between care providers and suppliers, oversight and development of educational and process improvement tools and resources required to promote the attainment of provider specific goals.

• Carry out the required consultative services via on-site field work, as well as, via various modes of off-site training models such as webinars, video conferences, etc.

• Plan and facilitate the implementation of provider site based projects and initiatives overseeing the acceleration and dissemination of best practice activities throughout the organization to ensure organizational alignment.

• Act as project lead to ensure all deliverables are met and provide on-going recommendations for clinical transformation and operational excellence that improves the provider opportunities for successful transformation and the Organization’s opportunities for achievement of strategic goals related to care delivery and improved member outcomes.

• Identify all relevant opportunities to advance and highlight provider performance strategies and accomplishments via presentations in diverse forums or publishing opportunities.

• Operate with the highest levels of autonomy and independence.

• Demonstrate an expert level of knowledge in facilitating and advancing projects.

• Contribute to the identification and pursuit of opportunities for process improvements and innovations.

• Coordinate significant corporate resources as a means of achieving results.

• Interface with internal stakeholders as subject matter experts of the department’s strategic efforts.

• Serving as the interface between the various departments/data sources and the provider network (hospitals, health systems, ancillary services, primary care physicians and specialists).

• Utilize training tools, protocols and resources to implement network wide benchmarking and best practices to identify opportunities to reduce unnecessary variation in provider practice patterns, contain care costs and improve clinical outcomes.

• Solve unique and varied business problems that require risk assessment, sound business judgment and change management skills.

• Provide solid, actionable recommendations as to what he/she feels is the appropriate decision.

• Develop and maintain strong collaborative relationships with administrative and physician/clinical leaders of provider organizations, provider staff and all internal and external constituents to ensure concerns of all impacted parties are being considered in the transformation activities. This may include drafting letters on behalf of senior management, creating program manuals and training documentation, assembling pay-for-performance or other program achievement summaries and other documents that will be used within the company as well as by providers, group accounts, and the media.

• Other duties as assigned or requested.

QUALIFICATIONS

Minimum

• Bachelor’s Degree in a clinical or business discipline or relevant experience and/or education as determined by the company in lieu of bachelor's degree

• 5-7 years of experience in the healthcare industry (hospital clinical operations/management, physician practice management or clinical operations, ancillary provider management or clinical operations, and/or health insurance) with significant knowledge of and experience with various care delivery models

• Experience in health plan provider network performance management, care/case management, provider relations, provider contracting, etc.

Preferred

• MBA, MPH or other master’s level clinical degree preferred.

• 7-10 years of experience in a managed care, hospital or other clinical setting preferred.

• Formal Lean Six Sigma, belted designation is a plus; formal CQI, TQI, process improvement-engineering education/training desired.

Skills

• Ability to work in a virtual team environment-accomplishing and coordinating work remotely

• Advanced data and statistical analysis skills with demonstrated proficiency in analyzing health care information and using that information to educate health care providers on their practice/utilization patterns and to influence a change in those practice patterns

• Ability to manage client engagements including meeting deadlines for project deliverables

• Ability to work in a fast paced, high visibility, high performing team environment that demands flexibility in working on multiple projects at any given time

• Excellent organizational, time management and project management skills;

• Excellent written and verbal communication skills including public speaking and web based training/education experience

• Excellent interpersonal skills (consensus building, negotiation and conflict resolution skills) with the ability to interact with a variety of internal and external constituents from all levels of an organization

• Broad knowledge and understanding of the health system from the perspective of federal and commercial payers/insurers, providers, regulators, third party quality organizations, etc.

• Excellent knowledge of and working experience with various software packages such as Microsoft PowerPoint, Excel, Word, Project, etc.

SCOPE OF RESPONSIBILITY

Does this role supervise/manage other employees?

No

WORK ENVIRONMENT

Is Travel Required?

Yes - up to 50%

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:

$57,700.00

Pay Range Maximum:

$106,700.00

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

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Req ID: J254553