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Highmark Health

Director Reimbursement Design & Market Evaluation

Highmark Health, Honolulu, HI, United States

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Company : Highmark Inc.

Job Description :

JOB SUMMARY

This 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 RESPONSIBILITIES

  1. Perform management responsibilities including hiring and termination decisions, coaching and development, rewards and recognition, performance management, and staff productivity.
  2. 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.
  3. Develop the overall conceptualization, strategy alignment, financial models, and high-level design of new reimbursement models for both government and private payers.
  4. Maintain a 3-5 year strategic roadmap outlining current and future reimbursement designs across markets and lines of business.
  5. Work in a Health Economist approach to build and maintain analytical models that evaluate reimbursement models.
  6. Develop and maintain strategic provider relationships to understand the current healthcare delivery state and test value-based programming concepts.
  7. Serve as a subject matter expert working with provider relations and clinical transformation consultants.
  8. Other duties as assigned or requested.

EDUCATION

Required:

  • Bachelor's Degree in Business, Finance, Healthcare Administration, or Related Field

Substitutions:

  • 6 years of relevant work experience

Preferred:

  • Master's Degree in Business or Healthcare Administration

EXPERIENCE

Minimum:

  1. 7 years in Healthcare, Healthcare Insurance, Consulting or related area
  2. 3 years in Value-based reimbursement, managed care contracting, provider reimbursement, consulting, or population health delivery
  3. 4 years in research and strategic planning around emerging trends in reimbursement
  4. 1 year working with technology vendors and other service provider solutions
  5. 2 years in a Health Economist capacity

Preferred:

  1. 5 years familiarity with alternative care model designs
  2. 5 years familiarity with healthcare service delivery and quality metrics
  3. 5 years experience in running large cross-organizational programs
  4. 5 years familiarity with health plan and provider contracting
  5. 3 years experience in Actuarial Science
  6. 2 years understanding of provider contract documents
  7. 1 year clinical background in a health system or large physician organization

LICENSES or CERTIFICATIONS

Required: None

Preferred: None

SKILLS

  1. Excellent written and oral communication skills
  2. Ability to manage multiple, complex projects
  3. Proficient in MS Office suite
  4. High level of autonomy and self-direction
  5. Strong financial background and analytical skills

Travel Requirement:

  • 0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type: Office-based

Physical work site required: Yes

Lifting: 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: $126,400.00

Pay Range Maximum: $236,000.00

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities.

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