Company :

Job Description : 

JOB SUMMARY

This job supports the acquisition of new accounts and retention of existing accounts by working directly with client managers within national and regional markets. The incumbent is primarily accountable for clinical analysis and preparation of reporting metric deliverables for Highmark customers, including healthcare consultants and brokers. The incumbent interprets client specific clinical data to assess clinical interventions that deliver clinical and financial results. They represent Clinical Strategy to maintain, improve and design reporting that meets the needs of the clients.

ESSENTIAL RESPONSIBILITIES

• Analyze client clinical data to determine trends and cost drivers that can be impacted by Highmark’s programs and services. Data set metrics include utilization and cost trends, prevalence and risk reporting, and aggregate population health management outcomes.
• Collaborate with Clinical Strategy Consultants, Health Management Strategy Consultants, Client Managers and other internal departments to prepare data analyses and deliverables that represent clinical management strategies and clinical capabilities to existing clients and potential clients.
• Develop and foster internal relationships across the organization and external vendor partners. Represent Clinical Strategy to maintain, improve and design reporting that demonstrate Highmark’s analytic insights, clinical capabilities, core/buy up product recommendations/outcomes and member engagement strategies.
• Research and stay current on health, wellness, productivity, risk and care management trends in the market place in order to share insights and best practices that should be illustrated in reporting/deliverables.
•  Support Client Strategy Team and Client Managers for clinical related inquiries.  Participate in internal workgroups as need, as subject matter experts.
• Responsible for identifying and completing a process improvement project at least annually in conjunction with Clinical Strategy leadership team.  Assist by providing appropriate content and consultation to support the RFP/RFI process.
• Other duties as assigned or requested.

EDUCATION

Required

• Bachelor's Degree in Nursing or a clinical related field

Substitutions

• None

Preferred

• Master's Degree in Business or a clinical related field

EXPERIENCE

Required

• 5 years in a clinical or managed care setting

To Include:

• 3 years of analyzing clinical outcome data
• 3 years of Project Management

Preferred

• 1 year designing outcome reporting and proficiency in reporting tools
• 1 year in a business or clinical environment with direct responsibility for applying technology

LICENSES or CERTIFICATIONS

Required

• None

Preferred

• Registered Nurse (RN)

SKILLS

• Critical thinking skills
• Understanding of key clinical concepts
• Strong proficiency in Microsoft Office, Cognos, Analytics Navigator and other similar databases
• Effective problem solving and decision making skills
• Effective written and verbal communication skills
• Strong business acumen
• Conflict and crisis management skills

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based

Teaches / trains others regularly

Frequently

Travel regularly from the office to various work sites or from site-to-site

Frequently

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

Never

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:

Pay Range Maximum:

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 any category protected by applicable federal, state, or local law.

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