Job Description :
This position leads the operational execution of value based reimbursement program implementation for the Organization's provider partners, including PCPs, specialists, facilities and health systems. This position is accountable for operationalizing all programming components (e.g., choosing appropriate measures and benchmarks for provider performance on cost and quality, developing scores and weighting within programs, preparing documents to file with Department of Health) and recommending or enhancing capabilities (e.g., data exchange, provider performance management) by working with key stakeholders.
- Perform management responsibilities to include, 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.
- Manage design implementation and operational execution of value based reimbursement programming adhering to specific timelines, as well as demonstrating excellent project management skills with defined project milestones. Support the implementation of strategic programming for PCPs, specialists, facilities and health systems including, but not limited to, the Organization, True Performance, Quality Blue Hospital Pay for Value, gain/risk share arrangements, transformative reimbursement programs in support of episodes of care/bundled payments and any future programming strategy.
- Accountable for fully operationalizing all value based reimbursement programming components (e.g., choosing appropriate measures for provider performance on cost and quality, developing scores and weighting within programs, preparing documents to file with Department of Health) and capabilities (e.g., data exchange, provider performance management) working with key stakeholders.
- Assist departmental colleagues with the development of value based programming communication plans and educational materials for internal and external audiences. Responsible for identifying and proactively communicating value based transformation concepts with internal and external stakeholders as implementation occurs. May represent the Organization as the subject matter expert on value based programming at external meetings with providers, professional societies, key thought leaders, or other key external parties, as necessary.
- Assist in the development of recommendations for a broad range of business, clinical, analytical and clinically technical capabilities.
- Other duties as assigned or requested.
Bachelor's Degree - Healthcare, Business, Finance, Economics, Accounting or other related area
Master's Degree - Business Administration (MBA), Healthcare related field
3 - 5 years’ experience in healthcare, and/or healthcare insurance, consulting, administration or related area
1 - 3 years' prior supervisory/management experience
- Working knowledge of physician practice management, hospital operations, comprehensive healthcare industry knowledge
- Extensive knowledge of clinical quality metrics and measures
- Conflict management, leadership and mentoring acumen experience
- Expert problem solving aptitude and adaptability to a dynamic work environment
- Expert interpersonal and relationship management skills, presentation skills, facilitation and negotiation skills, communication skills
- Experience with process engineering, improvement and continuous quality improvement methodologies
- Expert data interpretation and analytical skills
- Lead, motivate and direct professional staff; demonstrate accomplishment in collaboration with multi-disciplinary teams to achieve deliverables or outcomes within defined timelines (experience with project management)
Certified Professional in Healthcare Quality (CPHQ)
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
The physical, mental demands and working conditions described here are representative of those that must be met by an employee to successfully perform the essential functions of their job. Working conditions in which an individual or staff works, including but not limited to such things as amenities, physical environment, stress and noise levels. Reasonable accommodations may be made as appropriate to enable individuals with disabilities to perform essential duties.
Office - Based
An employee in this position works in an office environment. The position frequently requires the employee to communicate well with others both inside and outside the workplace (e.g., in person, via telephone, via email). The employee must be able to understand, interpret and analyze data, solve problems, concentrate, and research, use available technological resources and systems (e.g., computer programs), multi-task, prioritize, and meet multiple deadlines to complete essential tasks. The employee generally works in a fast-paced and frequently stressful environment, must attend work on a regular and reliable basis as well as adhere to all workplace policies, and may be called upon to work outside regular business hours.
Teaches/trains others regularly
Travel regularly from the office to various work sites or from site-to-site
Does Not Apply
Works primarily out-of-the office selling products/services (sales employees)
Does Not Apply
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 position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
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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