Endorsed
JOB SUMMARY
This job is the primary liaison between "strategic" provider groups in the Highmark network and the corporation. The incumbent will be responsible for cultivating relationships with large/complex provider groups to gain buy in and “sell” strategic initiatives for the purposes of piloting and implementing alternative care/reimbursement models. This job will maintain visibility in the provider community by representing the organization at various provider functions, meetings, and collaboratives. This job will play an active role in network management, training, monitoring and enforcement of company policies and procedures while increasing provider efficiencies; participate as a regional representative on key operational /product/medical management/reimbursement projects/initiatives that impact providers (i.e. oncology pathways, telemedicine, convenience care); recruit and introduce the Pay for Value (P4V) programs to the physician network; and work collaboratively with the physician practices that contract into the programs to reinforce and improve quality, to enrich the patient experience and to reduce the overall cost of care for members.
ESSENTIAL RESPONSIBILITIES
• Assume a leading role in the education and implementation of the provider network and contracting strategies for all assigned providers. Lead and manage relationship with assigned providers to proactively measure, anticipate and prevent problems as well as continually improve operational efficiencies and achieve corporate objectives around programs and strategic initiatives with providers. Proactively identify provider issues; recommends solutions and ensures provider receives the necessary support and resources to carry out the solutions. Coordinate in a matrixed liaison role with operations and support areas to ensure the appropriate development and execution of initiatives, communication needs, and issue resolution.
• Lead and manage activities to implement the provider network and contracting strategies for the "strategic" provider groups within the region. Partner with key provider groups to gain buy-in and “sell” strategic initiatives for the purposes of piloting and implementing alternative care/reimbursement models. Act as a conduit back to project teams for provider input and feedback on strategic initiatives. Work to gain consensus and incorporate necessary plan modifications. Assist with contracting as it relates to implementing key provider strategies.
• Drive the high level interactions and direction of the Pay for Value (P4V) relationships. Communicate with the appropriate business leaders on the P4V program participation, opportunity, performance, and progress. Engage appropriate resources, tools, analytics, and reports to enable success in the programs to drive better health outcomes, lower unit costs, and higher patient satisfaction for our members.
REQUIRED EDUCATION
Bachelor's Degree - Business, Healthcare related field
Substitutions
Prior experience in provider relations, healthcare or insurance industry
EXPERIENCE
Minimum:
• 7 - 10 years' experience in the healthcare/insurance industry
Preferred:
• 3 - 5 years' experience in presenting concepts to varying audiences
• 3 - 5 years' project management experience or other relevant experience with high accountability for managing multiple tasks with defined deadlines
KNOWLEDGE, SKILLS & ABILITIES
• In-depth understanding of the provider community (market knowledge) and global understanding of care delivery models and the insurance industry
• Knowledge of reimbursement methodologies and models as well as financial and analytical modeling
• Public speaking/delivering presentations
• Negotiation skills
• Process/quality improvement
• Strong written and oral communication and organizational/project management skills
• Broad knowledge and working experience with various software packages such as Microsoft PowerPoint, Excel, Word
• Knowledge of required compliance with Centers of Medicaid and Medicare services (CMS) laws and regulations, policies and guidelines regarding Medicare Advantage and Medicaid plans; HIPAA privacy and security regulations
TRAVEL REQUIREMENT:
50% - 75%
PHYSICAL, MENTAL DEMANDS AND WORKING CONDITIONS
Position Type: Most on-the-road
Most On-The-Road Positions
An employee in this position may work in a home or company office environment but is also frequently driving to and from various locations to perform the work off-site. The position frequently requires the employee to communicate effectively 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., computers and 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
Occasionally
Travels regularly from the office to various work sites or from site-to-site
Frequently
Physical Work Site Required
No
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:
$79,300.00
Pay Range Maximum:
$127,100.00
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 any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org