Manager Provider Government Programs

Highmark Health • PA, Working at Home - Pennsylvania, PA

2d • $94,200 - $151,000 • Hybrid

About The Position

This job is responsible for the performance and development of the clinical consultants into highly functioning subject matter experts in the Organization's Primary Care Provider government programs and continuous improvement models in a matrix management environment. This includes responsibility for value creation, impact and cost control, inter-departmental outcomes/goals based upon Highmark’s fiscal ROI target results in the program(s), such as improvements in quality, cost and utilization through care gap closure, STARS ratings and risk revenue performance as defined by the government program. This role can be hybrid or remote. If you live within 50 miles of an office you are required to be onsite 3 days a week. T, W, Th.

Requirements

• Bachelor's Degree- Clinical specialty or healthcare related field
• Minimum: 5 years’ experience in any combination of healthcare, government quality improvement programs, Medicare/Medicaid and risk revenue, medical staff management, healthcare consulting in government business, primary care administration, including revenue cycle management, or related area.
• 3 years' experience in government program quality improvement, data analysis, and strategic plan development based upon data.
• 3 years' of progressive management experience.
• Must be able to effectively resolve issues and problems across all areas of the corporation, by understanding corporate strategies, policy and scope of authority.
• Because of the broad impact of decisions that are made, the incumbent must be knowledgeable and sensitive to many internal and external corporate issues
• Aptitude for a high visibility position demanding integrity, uncompromising professionalism, diplomacy, conflict management, experience in managing provider and administrative leadership relationships, political awareness, superior written and verbal communication skills, superior listening skills, excellence in strategic planning, and ability to flex staff and departmental direction in response to outcomes dashboards for superior results
• Deep, operational interpretation/understanding of outcomes data and financial reports
• Superior communication and interpersonal relationship skill with both internal and external stake-holders
• Experienced in data analysis and interpretation, performance in outcomes based staff management, Medicare STARS, Medicaid HEDIS and risk revenue
• Highly skilled strategic thinker and executer in the development and deployment of a high performing staff

Nice To Haves

• Master's Degree - Business or Healthcare Administration discipline.
• Matrix management, strategic planning and execution experience
• Lean Six Sigma, TQI, CQI, other total quality, process engineering training/certification is a plus
• Project Management certification is a plus
• Clinical Licensure is highly desirable, and ability to manage/lead highly trained clinical professional level employees is essential
• Certified Professional in Healthcare Quality, American College of Healthcare Executives certification, preferred

Responsibilities

• Performs management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.
• Plans, organizes, staffs, directs and controls the day-to-day operations of the department; develops and implements policies and programs as necessary; may have budgetary responsibility and authority.
• Responsible for value creation, impact and cost control through the departmental day to day operations and clinical consultant performance in meeting or exceeding the ROI and fiscal targets as set by Highmark, cost and utilization and quality results in Medicare STARS, Medicaid HEDIS and risk revenue government programs. This includes accountability for team development to provide subject matter experts to the Organization Entity, provider network, innovations and partnership department, provider relations, and Highmark’s strategic PCP partners in government programs in Medicare, Medicaid HEDIS and risk revenue, and user interfaces endorsed by the Organization.
• Participates in the research, development and implementation of innovative strategic plans based upon analysis and interpretation of the outcomes and financial data to align with Highmark’s entity wide fiscal/ROI and performance goals. This requires superior commination skills in developing, maintaining and managing collaborative relationships and reporting structures with key internal and external stake holders and includes driving the continuous improvement process activities to enhance departmental performance and reduce administrative costs.
• Responsible for collaboration with operations team for government program management and meeting ROI/fiscal goals set by the Organization. This includes remaining current in market trends, government cost and quality programs, and innovative research in primary care models of care delivery.
• Through strategic assessment and execution, responsible to assess market needs/gaps, on an on-going basis, based upon financial/ROI outcomes, and develop/implement mitigation plans to meet needs/gaps.
• Responsible for building and sustaining relationships with the Organization provider network(s), regulators, professional/clinical societies and other organizations endorsed by the Organization for success of government program outcomes.
• Other duties as assigned or requested.

Benefits

• 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 any category protected by applicable federal, state, or local law.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager