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Director Market Provider Engagement
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Director Market Provider Engagement
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Wilkes-Barre PA, 18711, 19 N Main St
Company :
Highmark Inc.
Job Description :
JOB SUMMARY
This role leads a team responsible for fostering and maintaining positive, strategic relationships between Highmark and the provider and health system community. The leader oversees the team"s engagement with provider entities on performance-related initiatives, including Value-Based Reimbursement (VBR), Stars, and Risk capture, as well as other organizational solutions. This position also drives the team"s understanding of market trends, industry dynamics at both macro and micro levels, and current technologies to ensure optimal outcomes for both providers and the organization.
ESSENTIAL RESPONSIBILITIES
Lead and mentor a team responsible for identifying and cultivating strategic relationships with providers in value-based arrangements, focusing on entities beyond the Top 40. This includes guiding the team in establishing key contacts across all critical areas of identified provider entities/systems.
Direct the administration of critical and timely communication to providers through various channels such as ongoing personal contacts, site visits, regional communication sessions, and meetings with professional organizations to effectively disseminate initiatives and changes.
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.
Collaborate closely with the Market Executive to lead the analysis and data-driven decision-making process for initiatives, ensuring appropriate returns on investments, improved quality, cost reduction, and increased patient satisfaction.
Oversee the team"s collaboration with actuary and informatics teams to develop impactful population health tools/reports, care alignment reports, and other resources that deliver significant value for Highmark, provider partners, and members.
Empower the team to leverage data for informed decision-making, cultivate advanced negotiation skills within the team to achieve desired results, and champion strong project management practices to ensure the successful execution of commitments.
Drive collaborative efforts across the internal enterprise and facilitate the establishment of robust networks to optimize provider engagement strategies.
Ensure efficient and impactful communication strategies in close partnership with the Provider Engagement team, including the coordination and execution of provider advisory groups, forums, and events hosted by Highmark.
Strategically guide the team in identifying, developing, and growing provider relationships through collaborative efforts that drive future transformation in care delivery and reimbursement models. This involves fostering cross-functional collaboration with various internal departments and external 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
5 years of Management or leadership role
Experience with data analytics and trending
Preferred
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
Preferred
LICENSES or CERTIFICATIONS
Required
Preferred
Language (Other than English):
Travel Required:
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Physical work site required
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.
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
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Highmark Health is an independent licensee of the Blue Cross Blue Shield Association.
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.
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Highmark provides millions of people with the security of quality health insurance
Our history of helping families and companies with their health insurance needs dates to the 1930s, when our predecessor companies were established to help Pennsylvania's residents pay for health care.
Highmark was created in 1996 by the consolidation of two Pennsylvania licensees of the Blue Cross and Blue Shield Association — Pennsylvania Blue Shield (now Highmark Blue Shield) and Blue Cross of Western Pennsylvania (now Highmark Blue Cross Blue Shield). We are now one of the largest health insurers in the United States.
Highmark's officers and board of directors set the company's strategic direction and corporate policies. They are guided by our mission, vision and values.