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Value-Based Reimbursement Strategic Partners Consultant
Company : Highmark Inc.
Job Description :
JOB SUMMARY
This job works closely with management, and assists in developing new reimbursement models for the Organization's strategic partners and initiatives. The incumbent influences VBR integration into the overall Enterprise strategy through collaboration with Senior-level internal/external stakeholders. Ensures a high degree of development, efficiency, and effectiveness on the support and deployment of all VBR Design models.
ESSENTIAL RESPONSIBILITIES
- Support and lead, as needed, the development and completion of sales cycle (from model conception to implementation) of VBR programs for key strategic accounts and/or initiatives. Support strategic provider relationships to understand the current health care delivery state, readiness for change, test value based programming concepts and components, identify key partners, identify and proactively communicate market transformation concepts with provider and professional advocacy societies and key thought leaders.
- Ensure integration with Enterprise/PNR strategic direction. Collaborate with PNR stakeholders to incorporate VBR into product, network, and provider integration. Liaison with Enterprise & P&L leaders on their overarching strategies to ensure broader alignment of VBR approach. Develop targeted reimbursement models that support enterprise strategic initiatives that might fall outside of planned value-based reimbursement designs and/or to serve as a focus of innovation.
- Build collaborative relationships within the organization, external local, regional and national healthcare industry leadership to both inform market transformation strategies as well as to externally advance the organization's vision for care delivery transformation. Relationships will include internal areas of the enterprise such as the strategic, financial, and clinical leadership of the enterprise, in addition to the multiple areas of health plan.
- Support development of the overall conceptualization, strategy alignment, and high-level design of new value-based reimbursement models for PCPs, specialists, and health systems across the Organization's footprint, based on deep understanding and knowledge of trends in other areas of the country with both government and private payers. Programs will include but not be limited to pay-for-value programs, episode payments, prospective bundled payments, gain share and risk share models and will be implemented for the Organization's Medicare Advantage, Medicaid, ACA, and commercial populations with the goal of maximizing quality while reducing healthcare costs.
- Work with reimbursement, actuary, and analytic departments to ensure that operational capabilities are built in line with the strategic roadmap to ensure maximum flexibility and speed to market.
- Serve as a subject matter expert working in concert with provider relations and clinical transformation consultants to explain new programs and results to key provider partners.
- Collaborate with and support the senior Strategic Partners Consultant role as needed.
- Other duties as assigned or requested.
EDUCATION
Required
- Bachelor's Degree in Public Health, Health Administration, Economics, Mathematics, Engineering, Marketing, Business Communications or related field
Substitutions
- 6 years of related and progressive experience in lieu of Bachelor's degree
Preferred
- Master's Degree in Public Health, Health Administration, Economics, Mathematics, Engineering, Marketing, Business Communications or related field
EXPERIENCE
Required
- 5 years in the Health Insurance industry, Healthcare industry and relationship management
Preferred
- 5 years of Consulting
- 1 year in a Provider facing role
- 1 year with Provider payment/reimbursement
- 1 year with strategic planning/corporate development
LICENSES AND CERTIFICATIONS
Required
Preferred
SKILLS
- Analysis of business problems/needs
- Consulting
- Innovation
- Oral & Written Communication Skills
- Problem Solving & Decision Making
- Project Management
- Strategic Partnerships
- Strategic Relationship Building
- Strategic Thinking
- Strategy
Language (Other than English)
None
Travel Required
0%- 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office-based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 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. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
