"Alerted.org

Company :

Endorsed

Job Description :

JOB SUMMARY

This job is responsible for clinical value initiatives that lower medical spend and improve quality within assigned business unit. The incumbent will also be responsible for clinical client or provider performance management. Is accountable for the identification of high cost trends, as well as the execution, and value realization of strategic actions aimed at improving the health of the population and reducing cost. The incumbent is accountable for the development of strategic direction for value creation and management of the day-to-day operation including analysis of data and identification of trends, execution of solutions to address root cause issues, ongoing monitoring of solution effectiveness and adjustment of solutions as needed. Oversees the client or provider performance programs which include Cross Functional Owners (indirect, matrix reports) and will support in the identification, design, and execution of trends and solutions. Accountable for driving revenue value through a comprehensive risk assessment function as applicable.

ESSENTIAL RESPONSIBILITIES

+ 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.

+ Serves as a liaison/engage with sales team partners to ensure performance guarantees are appropriate, achievable and staffing impacts/value tradeoffs are objectively understood.

+ Lead Start-up/onboarding of Product buy-up programs that will be supported by the business unit, Collaborate with sales and product during the design process related to buy-ups to ensure design is achievable and will deliver value; ongoing management of program metrics.

+ Development, onboarding/launch of new clinical initiatives that promote clinical performance and are aligned to cost reduction or client program performance.

+ Coordinate and align resources, training, technologies and processes to achieve medical cost reduction targets and the Organization's strategic goals.Support the execution of financial analysis and data analytics processes that enable the team to identify ways to reduce medical cost spend and meet the Organization's strategic targets. Use analytics to drive decision making and prioritizing.

+ Produce a communication strategy to ensure all internal stakeholders are aware of their action items and are held accountable. Execute on the communication strategy. Consistent management across all value and program based targets at regular cadence in coordination with Business Planning and Performance.

+ Other duties as assigned or requested.

EDUCATION

Required

+ Bachelor's Degree

Substitutions

+ 6 years of related and progressive experience in lieu of Bachelor's degree

Preferred

+ Master's Degree

EXPERIENCE

Required

+ 7 years in Health Insurance Industry OR Clinical Programs OR Clinical Services

To Include

+ 5 years in a management role

+ 3 years with medical cost management

Preferred

+ None

LICENSES or CERTIFICATIONS

Required

+ None

Preferred

+ None

SKILLS

+ Influence and Persuasion

+ Collaborative Problem Solving

+ Leading Change

+ Conflict Management

+ Presentation Skills

+ Business Transformation

+ Developing People

+ Delegation

+ Process Improvement

+ Stakeholder Management

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based

Teaches / trains others regularly

Frequently

Travel regularly from the office to various work sites or from site-to-site

Occasionally

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 any category protected by applicable federal, state, or local law.

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Req ID: J270323