Company :Highmark HealthJob Description : 

JOB SUMMARY

This job is directly responsible for value creation, impact and cost control, and fiscal/ROI targets as set by the Organization, including revenue streams, and the engagement of hospitals and health systems enrolled in the organization's value-based reimbursement programs and continuous improvement models. The incumbent is a highly skilled subject matter expert (SME) in the organization's value-based reimbursement hospital programs who provides strategic, hands-on, facility based support to hospitals and health systems for analysis of performance in quality, cost and utilization scores, identifies opportunities for value creation, cost and utilization control, improvement in fiscal and quality performance, and develops strategic plans in collaboration with hospitals and the interdepartmental teams for transformation of workflows resulting in outstanding outcomes in the Organization's value-based reimbursement hospital program(s). Further, in a matrix management environment, this job is responsible for collaborative work with other functions in the provider area, data analytics, and key internal/external stake holders to provide the most appropriate support to the hospital and health system based upon data analysis and dashboard reports.

ESSENTIAL RESPONSIBILITIES

Process Improvement: Provides assistance and evaluates the hospital/health system’s current processes and/or resources to identify any opportunities to streamline and improve the current processes. Provide assistance to hospital and health systems seeking accreditation programs/processes and in the use of health information data exchanges, user interfaces, predicative analytic tools, and other population health management tools endorsed by the organization. Provides feedback to and collaborates with internal matrix partners to enhance and/or improve the hospital/health system resources, reporting and program materials. Transformation: Directly responsible to provide hospital facility based, hands on and/or virtual consultative workflow transformation, process improvement, training and education to all assigned hospital and health systems enrolled in the value-based reimbursement programs. Utilize a communication and collaboration method to drive engagement, enhance resources and tools available, exemplary value creation, impact and cost control, and ROI/fiscal outcomes for the hospital facility, including an ROI to Highmark Health. Strategic Planning: Functions as the Organization’s representative Subject Matter Expert in Hospital value-based reimbursement programs and data analysis for both internal and external key stakeholders and audiences. Independently and autonomously manage hospital and health system caseloads, projects, meetings, deliverables, resources etc. for individualized strategic plans to transform hospitals and/or health systems participating in value-based reimbursement program(s) using innovative continuous improvement methodologies. Cross train in all of the organization's value-based reimbursement programs to lend support as needed/defined by market outcomes. Communication: Assess the needs of each individual hospital facility, and use a combination of on-site individual facility based, health system level based, video conference, teleconference and electronic mail interactions to drive communication and engagement. Provide feedback to Highmark leadership and matrix partners to enhance hospital/health system support to improve participant engagement and program outcomes. Participates in the development and presentation of instructional materials for internal and external audiences. Collaboration: Responsible to work collaboratively with the hospital and/or health system to identify improvement opportunities to create strategic action plans to impact the quality, cost and utilization of care. Work collaboratively with the interdepartmental teams, matrix partners and key stakeholders to enhance the tools available and provide the most comprehensive support to the success of the contracted Hospital/Health Systems and Highmark Health.Data Analysis: Directly responsible to analyze and interpret provider and health system cost and utilization reports for the highest ROI opportunities and develop strategic plans to meet Specialty Program targets to improve quality, create value, impact and cost savings. Other duties as assigned or requested.

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EDUCATION

Required

Bachelor's Degree in a Clinical or Healthcare industry discipline

Substitutions

None

Preferred

Master's Degree in a Clinical or Healthcare industry discipline

EXPERIENCE

Required

5 years in any of the following healthcare areas:  the hospital facility environment OR  healthcare insurance industry OR healthcare administration in hospital and/or health systems, or healthcare consulting in hospital and/or health systems.

3 years’ experience in data analysis, interpretation, and outcomes strategic plan development

3 years of Value Based Reimbursement programs/Risk Revenue Value Streams/Population Health Management

Preferred:

7 years in managed care, hospital and health system management or other clinical setting

3 years with Lean, Six Sigma, TQI, TQC or other quality and/or project management certification.

3 years in health plan provider network performance management, population health management, continuous improvement or provider engagement models

LICENSES or CERTIFICATION

Required

None

Preferred

None

SKILLS

Must be able to effectively resolve issues and problems across all areas of the corporation, by understanding corporate strategies, policy and scope of authorityBecause of the broad impact of decisions that are made, must be knowledgeable and sensitive to many internal and external corporate issuesAptitude for a high visibility position demanding integrity, uncompromising professionalism, diplomacy and conflict managementDemonstrates a deep understanding of primary care practice operations and workflow across the continuum of variability in primary care and experience in managing provider and administrative leadership relationshipsSuperior written and verbal communication skills and listening skillsAbility to adapt engagement strategies to meet market needs

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based

Teaches / trains others regularly

Occasionally

Travel regularly 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

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.

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.

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. 

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