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

• 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

• Masters degree

LICENSES or CERTIFICATIONS

Required

• None

Preferred

• None

Language (Other than English):

• None

Travel Required:

• Less than 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

• Office-Based or Remote Position

Physical work site required

• Frequently

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.