Highmark Health
Director Reimbursement Design & Market Evaluation
Highmark Health, Baton Rouge, Louisiana, us, 70873
Overview
Company : Highmark Inc. Job Description
JOB SUMMARY This job supports the matrixed strategic design and analytical approach to reimbursement. The incumbent will work closely with stakeholders across the enterprise to develop and implement an integrated roadmap for the introduction and delivery of new and innovative reimbursement models across Highmark's markets and lines of business. This requires aligning new models to the health plan's strategic objectives based on understanding of innovation and industry trends in both the commercial and government lines of business. The team will support the development and maintenance of models that drive ROI and other decisions on payer partnership constructs, identify gaps in operational capabilities, build requirements to develop new capabilities, and tie them to Highmark's strategic capability roadmap. The role works across teams to inform and influence change to drive adoption and ROI realization. Key partners include Advanced Analytics, Contracting, Market and Provider Support teams, Actuary, Finance, Highmark Health Solutions, Health Plan Operations. Essential Responsibilities
Perform management responsibilities including hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plan, organize, staff, direct and control day-to-day operations; develop and implement policies and programs; may have budgetary responsibility and authority. Develop the overall conceptualization, strategy alignment, financial models, and high-level design of new reimbursement models for government and private payers, including fee-for-service, pay-for-value, episode payments, prospective bundled payments, gain share, and risk share models. Develops and maintains a 3-5 year strategic roadmap outlining current and future reimbursement designs with input from key executives. Stay informed of developments in public and private reimbursement, including CMS models, to ensure alignment with strategy. Work in a Health Economist approach to build and maintain analytical models evaluating reimbursement models. Continuously evaluate models and seek innovations based on data and market research. Collaborate with Contracting and Provider Relations Leaders and others to develop targeted reimbursement models supporting enterprise initiatives that may fall outside planned value-based designs. Develop and maintain strategic provider relationships to understand current health care delivery, readiness for change, test value-based programming concepts, identify partners, and communicate market transformation concepts with provider and professional advocacy groups and thought leaders. Serve as a subject matter expert with provider relations and clinical transformation consultants to explain programs and results. Other duties as assigned or requested. Education
Required Bachelor's Degree in Business, Finance, Healthcare Administration, or Related Field Substitutions
6 years of relevant work experience Preferred
Master's Degree in Business or Healthcare Administration Experience
Minimum 7 years Healthcare, Healthcare Insurance, Consulting or related area 3 years Value-based reimbursement, through managed care contracting, provider reimbursement, consulting, population health delivery or related areas 4 years Research and strategic planning around emerging trends in reimbursement, network, and payment model design. Demonstrated application of healthcare economic drivers and/or population health based analytics To include 1 year Experience working with technology vendors or service providers to source key capabilities 2 years Proven experience in a Health Economist role driving understanding of current health trends Preferred Experience
5 years Familiarity with alternative care model designs (e.g., patient-centered medical home, ACO), alternative reimbursement models (e.g., bundled payments), and provider/health plan quality programs (e.g., pay for performance) 5 years Familiarity with health care delivery across the continuum and quality metrics 5 years Experience in running large cross-organizational programs and projects 5 years Familiarity with health plan and provider contracting or revenue management 2 years Understanding of provider contract documents and contract management process Licenses or Certifications
Required None Skills
Excellent written and oral communication skills with ability to present complex information clearly and persuasively; strong leadership and the ability to relate to all levels of management, staff, and external partners Highly effective oral and written communication Ability to manage multiple, complex projects within timelines Proficient in MS Office suite and project management software Autonomy and self-direction to guide reimbursement model design from concept to execution Ability to navigate a complex organization and engage multiple stakeholders to achieve objectives Strong financial background and analytical skills with understanding of healthcare economic drivers Comfort with real-time calculations of cost, membership, etc. Language
None Travel Requirement
0% - 25% Physical, Mental Demands and Working Conditions
Position Type: Office-based Mentions of activities such as teaching or training, travel, and other physical demands are described as part of the role expectations; see original for details. Disclaimer and Compliance
The job description reflects the general nature and essential duties and responsibilities of the role and may not include all duties and qualifications required. Compliance: This job adheres to ethical and legal standards and company policy; employees may have access to confidential information and must comply with HIPAA and the company privacy policies and information security guidelines; and employees must comply with the Code of Business Conduct and applicable laws. Pay Range
Minimum:
$126,400.00 Maximum:
$236,000.00 Base pay is determined by candidate qualifications, experience, expected contributions, internal equity, market, and location; salary ranges may differ by geographic location. EEO and Accessibility
Highmark Health and its affiliates prohibit discrimination and strive to make the site accessible. For accommodation requests, contact HR Services Online at HRServices@highmarkhealth.org. California Consumer Privacy Act notice and Req ID: J267196
#J-18808-Ljbffr
Company : Highmark Inc. Job Description
JOB SUMMARY This job supports the matrixed strategic design and analytical approach to reimbursement. The incumbent will work closely with stakeholders across the enterprise to develop and implement an integrated roadmap for the introduction and delivery of new and innovative reimbursement models across Highmark's markets and lines of business. This requires aligning new models to the health plan's strategic objectives based on understanding of innovation and industry trends in both the commercial and government lines of business. The team will support the development and maintenance of models that drive ROI and other decisions on payer partnership constructs, identify gaps in operational capabilities, build requirements to develop new capabilities, and tie them to Highmark's strategic capability roadmap. The role works across teams to inform and influence change to drive adoption and ROI realization. Key partners include Advanced Analytics, Contracting, Market and Provider Support teams, Actuary, Finance, Highmark Health Solutions, Health Plan Operations. Essential Responsibilities
Perform management responsibilities including hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plan, organize, staff, direct and control day-to-day operations; develop and implement policies and programs; may have budgetary responsibility and authority. Develop the overall conceptualization, strategy alignment, financial models, and high-level design of new reimbursement models for government and private payers, including fee-for-service, pay-for-value, episode payments, prospective bundled payments, gain share, and risk share models. Develops and maintains a 3-5 year strategic roadmap outlining current and future reimbursement designs with input from key executives. Stay informed of developments in public and private reimbursement, including CMS models, to ensure alignment with strategy. Work in a Health Economist approach to build and maintain analytical models evaluating reimbursement models. Continuously evaluate models and seek innovations based on data and market research. Collaborate with Contracting and Provider Relations Leaders and others to develop targeted reimbursement models supporting enterprise initiatives that may fall outside planned value-based designs. Develop and maintain strategic provider relationships to understand current health care delivery, readiness for change, test value-based programming concepts, identify partners, and communicate market transformation concepts with provider and professional advocacy groups and thought leaders. Serve as a subject matter expert with provider relations and clinical transformation consultants to explain programs and results. Other duties as assigned or requested. Education
Required Bachelor's Degree in Business, Finance, Healthcare Administration, or Related Field Substitutions
6 years of relevant work experience Preferred
Master's Degree in Business or Healthcare Administration Experience
Minimum 7 years Healthcare, Healthcare Insurance, Consulting or related area 3 years Value-based reimbursement, through managed care contracting, provider reimbursement, consulting, population health delivery or related areas 4 years Research and strategic planning around emerging trends in reimbursement, network, and payment model design. Demonstrated application of healthcare economic drivers and/or population health based analytics To include 1 year Experience working with technology vendors or service providers to source key capabilities 2 years Proven experience in a Health Economist role driving understanding of current health trends Preferred Experience
5 years Familiarity with alternative care model designs (e.g., patient-centered medical home, ACO), alternative reimbursement models (e.g., bundled payments), and provider/health plan quality programs (e.g., pay for performance) 5 years Familiarity with health care delivery across the continuum and quality metrics 5 years Experience in running large cross-organizational programs and projects 5 years Familiarity with health plan and provider contracting or revenue management 2 years Understanding of provider contract documents and contract management process Licenses or Certifications
Required None Skills
Excellent written and oral communication skills with ability to present complex information clearly and persuasively; strong leadership and the ability to relate to all levels of management, staff, and external partners Highly effective oral and written communication Ability to manage multiple, complex projects within timelines Proficient in MS Office suite and project management software Autonomy and self-direction to guide reimbursement model design from concept to execution Ability to navigate a complex organization and engage multiple stakeholders to achieve objectives Strong financial background and analytical skills with understanding of healthcare economic drivers Comfort with real-time calculations of cost, membership, etc. Language
None Travel Requirement
0% - 25% Physical, Mental Demands and Working Conditions
Position Type: Office-based Mentions of activities such as teaching or training, travel, and other physical demands are described as part of the role expectations; see original for details. Disclaimer and Compliance
The job description reflects the general nature and essential duties and responsibilities of the role and may not include all duties and qualifications required. Compliance: This job adheres to ethical and legal standards and company policy; employees may have access to confidential information and must comply with HIPAA and the company privacy policies and information security guidelines; and employees must comply with the Code of Business Conduct and applicable laws. Pay Range
Minimum:
$126,400.00 Maximum:
$236,000.00 Base pay is determined by candidate qualifications, experience, expected contributions, internal equity, market, and location; salary ranges may differ by geographic location. EEO and Accessibility
Highmark Health and its affiliates prohibit discrimination and strive to make the site accessible. For accommodation requests, contact HR Services Online at HRServices@highmarkhealth.org. California Consumer Privacy Act notice and Req ID: J267196
#J-18808-Ljbffr