Value-Based Reimbursement Strategic Partners Consultant-Remote Role

Company : Highmark Inc. Job Description : JOB SUMMARY This job works closely with management, and assists in developing new reimbursement models for the Organization's strategic partners and initiatives. The incumbent influences VBR integration into the overall Enterprise strategy through collaboration with Senior-level internal/external stakeholders. Ensures a high degree of development, efficiency, and effectiveness on the support and deployment of all VBR Design models. ESSENTIAL RESPONSIBILITIES Support and lead, as needed, the development and completion of sales cycle (from model conception to implementation) of VBR programs for key strategic accounts and/or initiatives. Support strategic provider relationships to understand the current health care delivery state, readiness for change, test value based programming concepts and components, identify key partners, identify and proactively communicate market transformation concepts with provider and professional advocacy societies and key thought leaders. Ensure integration with Enterprise/PNR strategic direction. Collaborate with PNR stakeholders to incorporate VBR into product, network, and provider integration. Liaison with Enterprise & P&L leaders on their overarching strategies to ensure broader alignment of VBR approach. Develop targeted reimbursement models that support enterprise strategic initiatives that might fall outside of planned value-based reimbursement designs and/or to serve as a focus of innovation. Build collaborative relationships within the organization, external local, regional and national healthcare industry leadership to both inform market transformation strategies as well as to externally advance the organization's vision for care delivery transformation. Relationships will include internal areas of the enterprise such as the strategic, financial, and clinical leadership of the enterprise, in addition to the multiple areas of health plan. Support development of the overall conceptualization, strategy alignment, and high-level design of new value-based reimbursement models for PCPs, specialists, and health systems across the Organization's footprint, based on deep understanding and knowledge of trends in other areas of the country with both government and private payers. Programs will include but not be limited to pay-for-value programs, episode payments, prospective bundled payments, gain share and risk share models and will be implemented for the Organization's Medicare Advantage, Medicaid, ACA, and commercial populations with the goal of maximizing quality while reducing healthcare costs. Work with reimbursement, actuary, and analytic departments to ensure that operational capabilities are built in line with the strategic roadmap to ensure maximum flexibility and speed to market. Serve as a subject matter expert working in concert with provider relations and clinical transformation consultants to explain new programs and results to key provider partners. Collaborate with and support the senior Strategic Partners Consultant role as needed Other duties as assigned or requested. EDUCATION Required Bachelor's Degree in Public Health, Health Administration, Economics, Mathematics, Engineering, Marketing, Business Communications or related field Substitutions 6 years of related and progressive experience in lieu of Bachelor's degree Preferred Master's Degree in Public Health, Health Administration, Economics, Mathematics, Engineering, Marketing, Business Communications or related field EXPERIENCE Required 5 years in the Health Insurance industry, Healthcare industry and relationship management Preferred 5 years of Consulting 1 year in a Provider facing role 1 year with Provider payment/reimbursement 1 year with strategic planning/corporate development LICENSES AND CERTIFICATIONS Required None Preferred None SKILLS Analysis of business problems/needs Consulting Innovation Oral & Written Communication Skills Problem Solving & Decision Making Project Management Strategic Partnerships Strategic Relationship Building Strategic Thinking Strategy Language (Other than English) None Travel Required 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. Pay Range Minimum: $67,500.00 Pay Range Maximum: $126,000.00 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) 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 number below. For accommodation requests, please contact HR Services Online at [email protected] California Consumer Privacy Act Employees, Contractors, and Applicants Notice Highmark Health is a national, blended health organization that includes one of America’s largest Blue Cross Blue Shield insurers and a growing regional hospital and physician network. Based in Pittsburgh, Pa., Highmark Health’s 35,000 employees serve millions of customers nationwide through the nonprofit organization’s affiliated businesses, which include Highmark Inc., Allegheny Health Network, HM Insurance Group, United Concordia Dental, HM Health Solutions and HM Home & Community Services. Highmark Health’s businesses proudly serve a broad spectrum of health-related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions.

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