Director Reimbursement Design & Market Evaluation

Company : Highmark Inc.Job Description :JOB SUMMARYThis job owns the strategic design and analytical approach to reimbursement. The incumbent will work closely with stakeholders across the enterprise in the development and implementation of an integrated roadmap for innovative reimbursement models across all of Highmark's markets and lines of business. This requires aligning new models to the health plan's strategic objectives based on a deep understanding of innovation and industry trends in both the commercial and government lines of business. This team will be responsible for developing and maintaining analytical models that will drive both the return on investment (ROI) and other decisions on the payer partnership constructs. These new approaches require new operational capabilities, and this team is responsible for identifying those gaps, building requirements to drive the development of new capabilities, and tying them to Highmark's strategic capability roadmap. Critical partners include Advanced Analytics, Contracting and Provider Relations, Actuary, Finance, Highmark Health Solutions, and Health Plan Operations.ESSENTIAL RESPONSIBILITIESPerform management responsibilities including 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 necessary policies and programs; may have budgetary responsibility and authority.Develop the overall conceptualization, strategy alignment, financial models, and high-level design of new reimbursement models for both government and private payers.Maintain a 3-5 year strategic roadmap outlining current and future reimbursement designs across markets and lines of business.Work in a Health Economist approach to build and maintain analytical models that evaluate reimbursement models.Develop and maintain strategic provider relationships to understand the current healthcare delivery state and test value-based programming concepts.Serve as a subject matter expert working with provider relations and clinical transformation consultants.Other duties as assigned or requested.EDUCATIONRequired:Bachelor's Degree in Business, Finance, Healthcare Administration, or Related FieldSubstitutions:6 years of relevant work experiencePreferred:Master's Degree in Business or Healthcare AdministrationEXPERIENCEMinimum:7 years in Healthcare, Healthcare Insurance, Consulting or related area3 years in Value-based reimbursement, managed care contracting, provider reimbursement, consulting, or population health delivery4 years in research and strategic planning around emerging trends in reimbursement1 year working with technology vendors and other service provider solutions2 years in a Health Economist capacityPreferred:5 years familiarity with alternative care model designs5 years familiarity with healthcare service delivery and quality metrics5 years experience in running large cross-organizational programs5 years familiarity with health plan and provider contracting3 years experience in Actuarial Science2 years understanding of provider contract documents1 year clinical background in a health system or large physician organizationLICENSES or CERTIFICATIONSRequired: NonePreferred: NoneSKILLSExcellent written and oral communication skillsAbility to manage multiple, complex projectsProficient in MS Office suiteHigh level of autonomy and self-directionStrong financial background and analytical skillsTravel Requirement:0% - 25%PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONSPosition Type: Office-basedPhysical work site required: YesLifting: up to 10 pounds (Constantly)Lifting: 10 to 25 pounds (Occasionally)Disclaimer: This job description indicates the general nature and essential duties and responsibilities of work performed by employees within this job title.Pay Range Minimum: $126,400.00Pay Range Maximum: $236,000.00Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities. #J-18808-Ljbffr