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Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This job is responsible for the oversight of the Medicaid contract and is available for prompt response to direct inquiries from the state regulators. The incumbent will be readily available to the state regulator for both planned and ad hoc meetings, reports and requests. Will work collaboratively with multiple stakeholders and various cross-functional teams, locations and departments to meet or exceed state contractual performance requirements, overall profitability, member satisfaction and state regulator satisfaction. Lead efforts to capture plan performance, work with vendor partners to identify opportunities for improvement. Work with vendor partners to design, implement and execute strategies and work with cross-functional clinical, pharmaceutical, operational, IT and other teams to ensure overall goals of the organization are met and to optimize outcomes. The incumbent will collaborate with the organization’s government markets and Medicaid leadership committees to coordinate the implementation of new programs and projects including the report development to ensure these initiatives remain on track. The incumbent will be responsible the oversight of all state regulatory contractual requirements and to help achieve the Organization's overall performance objectives. The incumbent will be responsible for escalating cross-portfolio dependencies, project risks, and items for management attention to the executive leadership group.

ESSENTIAL RESPONSIBILITIES

+ Manage and oversee the state’s managed care organization (MCO) contractual performance as specified in the contract and to help achieve the Organization's goals and objectives.

+ Directly accountable to leadership and the state regulator(s) to review and approve contractual deliverables and to respond to regulator ad hoc requests.

+ Partner with external vendors in the management of a portfolio of key initiatives through a disciplined, customer focused, program management approach; identifies and resolves project and program issues and risks.

+ Manage and review performance metrics, compliance standards, policies, and procedures; monitor implementation of remediation steps and corrective action plans necessary to address compliance issues and risks.

+ Develop and maintain local and state relationships and affiliations, which promote the success of the organization’s business interests.

+ Other duties as assigned or requested. ​

EXPERIENCE

Required

+ 5 years healthcare payer (insurance) or related experience.

+ 5 years of experience in an operations area.

+ 2 years in program oversight management/executive role.

+ Experience supporting internal and/or external regulatory audits

+ Medicaid experience

Preferred

+ None

SKILLS

+ Leadership experience in functional and matrix aligned organizations

+ Previous consulting in a principle/manager/director role; portfolio management experience

+ Strong communication and interpersonal skills

+ Strong understanding of software development life-cycle methodology

+ Strong understanding of portfolio management methodology

EDUCATION

Required

+ Bachelor’s degree in business, marketing, health administration of related field OR relevant experience and/or education as determined by the company in lieu of bachelor's degree.

Preferred

+ Master degree business or health administration

LICENSES or CERTIFICATIONS

Required

+ None

Preferred

+ None

Language (Other than English):

None

Travel Requirement:

25% - 50%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office- or Remote-based

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

Frequently

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:

$78,900.00

Pay Range Maximum:

$147,500.00

_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 [email protected]

California Consumer Privacy Act Employees, Contractors, and Applicants Notice

Req ID: J256800