Market Director - SEPA Market
Market Director - SEPA Market
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Salary Not Disclosed
1 Vacancy
Job Description
Company :
Highmark Inc.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 performancerelated activities such as ValueBased 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 valuebased 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 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
7 years of experience in the health care/health insurance industry to include valuebased 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
Bachelors degree or relevant experience and/or education as determined by the company in lieu of bachelors degree.
Preferred
Masters degree.
LICENSES or CERTIFICATIONS
None
Preferred
None
Language (Other than English):
None
Travel Requirement:
0 25
PHYSICAL MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office or Remotebased
Teaches / trains others
Occasionally
Travel from the office to various work sites or from sitetosite
Rarely
Works primarily outofthe 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 Companys Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore it is every employees responsibility to comply with the companys 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.
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Required Experience:
Director
Employment Type
Full-Time
