JOB SUMMARY
The job works directly with network providers to champion provider practice transformation in support of various Organization endorsed strategic care delivery models. Leads the day to day execution of projects, initiatives and significant work streams related to provider transformation and performance excellence in various health care delivery settings. The incumbent serves as the primary catalyst in identifying and facilitating change in the form of industry standard evidence-based best practice improvement opportunities that are required to accelerate the achievement of goals related to clinical operations excellence and optimal, sustained patient care (as manifested by patient outcomes).
This role requires the right candidate to be a resident of West Virginia. We are looking for 2 people for this role. One person who lives in the Northern part of West Virginia and a second person to live in the Southwest portion of West Virginia.
ESSENTIAL RESPONSIBILITIES
QUALIFICATIONS
Minimum
Bachelor’s Degree in a clinical or business discipline or relevant experience and/or education as determined by the company in lieu of bachelor's degree5-7 years of experience in the healthcare industry (hospital clinical operations/management, physician practice management or clinical operations, ancillary provider management or clinical operations, and/or health insurance) with significant knowledge of and experience with various care delivery modelsExperience in health plan provider network performance management, care/case management, provider relations, provider contracting, etc.
Preferred
MBA, MPH or other master’s level clinical degree preferred. 7-10 years of experience in a managed care, hospital or other clinical setting preferred.Formal Lean Six Sigma, belted designation is a plus; formal CQI, TQI, process improvement-engineering education/training desired.
Skills
SCOPE OF RESPONSIBILITY
Does this role supervise/manage other employees?
No
WORK ENVIRONMENT
Is Travel Required?
Yes - up to 50%
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 position 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.
Pay Range Minimum:
$57,700.00Pay Range Maximum:
$106,700.00Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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