Company :

Job Description : 

GENERAL OVERVIEW:  

Lead and manage the development and maintenance of Highmark’s various provider networks for all lines of business and all market segments, with emphasis and ownership of the ancillary networks and multi-market providers. Develop and implement new reimbursement and care delivery models that result in cost trend control, higher care quality, appropriate access, and better member experiences. Create and implement innovative programs and services that integrate contracting strategies with Product, Clinical, and Reimbursement strategies.

ESSENTIAL RESPONSIBILITIES: 

• Oversee contract negotiations and network management programs for ancillary providers and national/multi-market providers.  Own and manage contract signatory authority for such provider contracts.

• Establish appropriate benchmarks and monitor parameters to ensure product and service competitiveness.

• Facilitate creation and/or adoption of innovative products and services to meet market demands. 

• Develop and implement pay-for-value contracts for a variety of ancillary providers across all markets.

• Provide oversight for the support of market-based provider initiatives including communications, contract issue resolution, C2V initiatives and high-performance network management.

• Collaborate with Home & Community Services / Helion to develop and implement a comprehensive network management strategy for post-acute care services with an emphasis on Skilled Nursing, Home Health, Inpatient Rehabilitation, and Long-term Acute Care.

• Lead and manage successful relationships with all internal stakeholders, particularly, Market-segment leadership, Reimbursement, Product, Payment Innovation, Medical Management, and Sales.

• Represent Highmark and the Provider Services division to external stakeholders, including Providers, Accounts, Regulatory entities, BCBSA, etc.

• Other duties as assigned or requested.

QUALIFICATIONS:

Minimum:

• Bachelor’s degree

• 7 years of experience in healthcare and/or managed care in a management role

• 7 years of experience in provider contracting, benefit design, medical management, or healthcare administration

Knowledge, Skills and Abilities :

• Excellent written and verbal communication skills

• Excellent presentation skills

• Strength in leadership and teamwork, strategic thinking, influencing skills, negotiating skills, and operations execution.

SCOPE OF RESPONSIBILITY 

• Does this role supervise/manage other employees?  Yes           

• If yes, indicate the number of direct reports:  1

WORK ENVIRONMENT

• Is Travel Required?     Yes           

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.

California Consumer Privacy Act Employees, Contractors, and Applicants Notice