Highmark Health Jobs

Company :

Allegheny Health Network

Job Description :

GENERAL OVERVIEW:

This job is responsible for designing, directing and deploying strategic and operational efforts across the network related to value-based programs to ensure optimal patient care and reimbursement outcomes.

ESSENTIAL RESPONSIBILITIES

• In collaboration with Sr. Leadership (CEOs, CMOs, CFOs, IQOs, VPs, etc.) of Quality, Facilities, Institutes, CIN, responsible for developing a network-wide strategy for Value-based Reimbursement programs, including the implementation of effective and efficient population health workflows and capture of optimal VBR earnings. Support the development of managed care / CMS strategies and initiatives to adapt to ongoing healthcare payment reforms and evolving payment methodologies.

• Lead a team of value specialists (e.g., Quality Specialists, Clinical Integration Managers, Population Health Coordinators, and Analysts) who support clinical and operational leaders, providers and care teams in understanding and executing upon the population health and value-based care strategy to yield optimal patient and reimbursement outcomes.

• Collaborate with VPs Contracting, Quality Analytics and CIN leadership to evaluate risk, financials and negotiate the Value Based Reimbursement (VBR) contracts for commercial payers. Act as an advisor related to VBR program metrics (cost, quality, utilization, patient experience, etc.).

• Collaborate with Enterprise and AHN Senior Leadership from Finance and Operations; Determine financial goals for VBR programs; provide ongoing financial estimates and evaluations; Evaluate impact of alternative proposals for new and renewing programs.

• Perform management responsibilities to include, but not limited to: involved in 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.

• SME for VBR. Act as advisor to senior leadership and clinical and operational teams in regards to emerging trends and methodologies for VBR programs; advises on strategies/tactics for success. Responsible for developing and deploying education around VBR programming for Enterprise, Network, Facility and Institute Senior Executives as well as key stakeholders for operations.

• Provide ongoing communication on progress, opportunities for improvement and direction on areas of focus throughout the year to various stakeholders and forums.

• Ensure the capture and management of all VBR-related data; ensure timely reporting and transmission of information; provide actionable analytics to inform decision making.

• Collaborate with Highmark enterprise partners and other payer representatives to define and implement strategies to maximize performance on VBR programs and ensure consistency of education and training to providers and staff on VBR programs.

• Other duties as assigned.

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QUALIFICATIONS:

Minimum

• Master's Degree in a Healthcare related field or relevant experience and/or education as determined by the company in lieu of Master’s degree

• 5 years in VBR Programming

• 3 years in a management or leadership role

• 1 year in an Education / Teaching / Public Speaking role

Preferred

• Finance experience

• Analytics

• VBR contract negotiation and management experience

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.

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Req ID: J241624