JOB SUMMARY
*Employee must be located in the Buffalo NY or Albany NY area *
This job is responsible for the administration and maintenance of positive, collegial relationships between the corporation and the provider and health system community. The incumbent is responsible for engaging entities on performance-related activities such as Value-Based Reimbursement (VBR), Stars and Risk capture, as well as other organizational solutions as appropriate. Additionally, they will keep up with market trends and industry dynamics, including at both a macro and micro level (examples of micro level include changes/expansion of services provided by physicians), and current technologies to ensure the company is ensuring optimum outcomes for both the provider and corporation.
ESSENTIAL RESPONSIBILITIES
Identify and cultivate relationships with providers in value-based arrangements outside of the Top 40 provider entities. Establish key contacts in all critical areas of the identified provider entity/system. Oversee administration of critical and timely communication to providers through ongoing personal contacts, site visits, regional communication sessions, meetings with professional organizations to communicate initiatives and changes.
In partnership with the Market Executive, conduct analysis and make data driven decisions to ensure we are getting appropriate returns on investments for initiatives, increasing quality, lowering cost, and increasing patient satisfaction. Work with actuary and informatics teams to develop population health tools/reports, care alignment reports, and other resources that will produce value for Highmark, the provider partner, and the member.
Utilize data to make informed decisions, negotiation skills to achieve desired results, and project management skills to ensure successful execution of commitments. Work collaboratively across the internal enterprise, establish networks to support provider engagement.
Promote efficient communications in close partnership with Provider Engagement including coordination of provider advisory groups, forums and events hosted by Highmark.
Identify, develop, and grow provider relationships through collaboration that will form the glide path for future transformation in care delivery and reimbursement models. This requires interfacing with various departments in the organization as well as vendor teams.
Other duties as assigned or requested.
EXPERIENCE
Required
7 years of experience in the health care/health insurance industry to include value-based care and provider relations/network management
Experience with data analytics and trending
Preferred
Experience working in provider or health system administrative or clinical role
SKILLS
Strong interpersonal organizational and analytical skills
Superior communication (written and oral), teamwork, organizational and leadership skills
Strong understanding of health care quality programs such as STARS, HEDIS
Understanding dynamics of matrix organization
EDUCATION
Required
Bachelor’s degree or relevant experience and/or education as determined by the company in lieu of bachelor's degree.
Preferred
Master's degree.
LICENSES or CERTIFICATIONS
Required
None
Preferred
None
Language (Other than English):
None
Travel Requirement:
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office- Hybrid
Teaches / trains others
Occasionally
Travel from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes - Hybrid
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
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:
$92,300.00Pay Range Maximum:
$172,500.00Base 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 any category protected by applicable federal, state, or local law.
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