Market Director - (SEPA Market)

Company :

Job Description :

JOB SUMMARY

*Incumbent must reside in Southeastern PA

This job is responsible for the administration and maintenance of positive, collegial relationships between the corporation and the provider and health system community. The incumbent is responsible for engaging entities on performance-related activities such as Value-Based Reimbursement (VBR), Stars and Risk capture, as well as other organizational solutions as appropriate. Additionally, they will keep up with market trends and industry dynamics, including at both a macro and micro level (examples of micro level include changes/expansion of services provided by physicians), and current technologies to ensure the company is ensuring optimum outcomes for both the provider and corporation.

ESSENTIAL RESPONSIBILITIES

• Identify and cultivate relationships with providers in value-based arrangements outside of the Top 40 provider entities. Establish key contacts in all critical areas of the identified provider entity/system. Oversee administration of critical and timely communication to providers through ongoing personal contacts, site visits, regional communication sessions, meetings with professional organizations to communicate initiatives and changes.

• In partnership with the Market Executive, conduct analysis and make data driven decisions to ensure we are getting appropriate returns on investments for initiatives, increasing quality, lowering cost, and increasing patient satisfaction. Work with actuary and informatics teams to develop population health tools/reports, care alignment reports, and other resources that will produce value for Highmark, the provider partner, and the member.

• Utilize data to make informed decisions, negotiation skills to achieve desired results, and project management skills to ensure successful execution of commitments. Work collaboratively across the internal enterprise, establish networks to support provider engagement.

• Promote efficient communications in close partnership with Provider Engagement including coordination of provider advisory groups, forums and events hosted by Highmark.

• Identify, develop, and grow provider relationships through collaboration that will form the glide path for future transformation in care delivery and reimbursement models. This requires interfacing with various departments in the organization as well as 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

• Experience with data analytics and trending

Preferred

• Experience working in provider or health system administrative or clinical role

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

• Bachelor’s degree or relevant experience and/or education as determined by the company in lieu of bachelor's degree.

Preferred

• Master's degree.
  

LICENSES or CERTIFICATIONS

Required

• None
  

Preferred

• None
  

Language (Other than English):

None

Travel Requirement:

0% - 25%

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

No

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.

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

California Consumer Privacy Act Employees, Contractors, and Applicants Notice