Highmark Health
Director Reimbursement Design & Market Evaluation
Highmark Health, Providence, Rhode Island, us, 02912
Highmark Health Director Reimbursement Design & Market Evaluation in Providence, Rhode Island
Company:
Highmark Inc.
Are you ready to apply Make sure you understand all the responsibilities and tasks associated with this role before proceeding. 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 the introduction and delivery of new and innovative reimbursement models across all of Highmark's markets and lines of business. This will require 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. ESSENTIAL RESPONSIBILITIES Perform 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 policies and programs as necessary; 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. Work in a Health Economist approach to build and maintain analytical models that evaluate reimbursement models and seek innovative ways to make improvements based on data and market research. Develop and maintain strategic provider relationships to understand the current health care delivery state and identify key partners. 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: 7 years in Healthcare, Healthcare Insurance, Consulting, or related area 3 years in Value-based reimbursement, managed care contracting, provider reimbursement, or related areas 4 years in research and strategic planning around emerging trends in reimbursement 1 year experience with technology vendors and service provider solutions 2 years in a Health Economist capacity Preferred: Familiarity with alternative care model designs and reimbursement models Experience in running large cross-organizational programs LICENSES or CERTIFICATIONS Required:
None Preferred:
None SKILLS Excellent written and oral communication skills Ability to manage multiple, complex projects Proficient in MS Office suite Strong financial background and analytical skills TRAVEL REQUIREMENT: 0% - 25% PHYSICAL, MENTAL DEMANDS, and WORKING CONDITIONS Position Type:
Office-based Lifting: up to 10 pounds - Constantly; 10 to 25 pounds - Occasionally; 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. Pay Range Minimum:
$126,400.00 Pay Range Maximum:
$236,000.00 Highmark Health prohibits discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities.
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Company:
Highmark Inc.
Are you ready to apply Make sure you understand all the responsibilities and tasks associated with this role before proceeding. 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 the introduction and delivery of new and innovative reimbursement models across all of Highmark's markets and lines of business. This will require 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. ESSENTIAL RESPONSIBILITIES Perform 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 policies and programs as necessary; 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. Work in a Health Economist approach to build and maintain analytical models that evaluate reimbursement models and seek innovative ways to make improvements based on data and market research. Develop and maintain strategic provider relationships to understand the current health care delivery state and identify key partners. 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: 7 years in Healthcare, Healthcare Insurance, Consulting, or related area 3 years in Value-based reimbursement, managed care contracting, provider reimbursement, or related areas 4 years in research and strategic planning around emerging trends in reimbursement 1 year experience with technology vendors and service provider solutions 2 years in a Health Economist capacity Preferred: Familiarity with alternative care model designs and reimbursement models Experience in running large cross-organizational programs LICENSES or CERTIFICATIONS Required:
None Preferred:
None SKILLS Excellent written and oral communication skills Ability to manage multiple, complex projects Proficient in MS Office suite Strong financial background and analytical skills TRAVEL REQUIREMENT: 0% - 25% PHYSICAL, MENTAL DEMANDS, and WORKING CONDITIONS Position Type:
Office-based Lifting: up to 10 pounds - Constantly; 10 to 25 pounds - Occasionally; 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. Pay Range Minimum:
$126,400.00 Pay Range Maximum:
$236,000.00 Highmark Health prohibits discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities.
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