, Texas

**Company :**

Highmark Health

**Job Description :**

**JOB SUMMARY**

This job manages design, implementation planning and execution of programs to improve appropriateness of care of Highmark’s members and patients. The incumbent will partner with lead clinicians and the Enterprise Care Analytics team to identify and measure patterns of unwarranted variation in care. The incumbent will then work with internal partner teams within the enterprise to deliver programs at scale that will promote high-value care for all members. Initiatives could be composed of provider levers (e.g., peer-to-peer physician engagement), payor levers (e.g., medical / reimbursement policy) or blended levers (e.g., value-based reimbursement models). Will possess a passion for improving value in care for patients and a skillset to drive change through influence and partnership.

**ESSENTIAL RESPONSIBILITIES**

+ Perform 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.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.

+ Manage a small team of direct and indirect reports to implement new clinical workflows or care models within the Allegheny Health Network and develop implementation plans to scale workflows to other strategic providers.

+ Partner with clinicians and analytics teams to identify patterns of unwarranted variation in care.Design provider-led interventions to promote improved performance.

+ Work withpartners from various internal functions across the enterprise to align medical policy with clinical guidelines and identify action levers for scaled enforcement.

+ Build business cases for priority initiatives that measure the impact to total cost of care and justify resource needs to deliver programs as relevant.

+ Other duties as assigned or requested.

**QUALIFICATIONS**

Required

+ Bachelor's Degree in nursing or a related clinical field OR a graduate of another relevant clinical program/6 years of related and progressive experience in lieu of Bachelor's degree will be considered

+ 5 years in Health Care Industry

+ 3 years in clinical practice

+ 3 years of Project Management

+ 3 years of Leadership / People Management

Preferred

+ Bachelor’s degree in Health Administration, Business Administration/Management, or related degree in addition to clinical degree

+ Master's Degree in Health Administration, Business Administration or related clinical degree

+ 3 years of clinical research

+ 3 years of analyzing clinical outcome data

+ 1 year in Medical Policy

**KEY SKILLS**

+ Business case development

+ Clinical Quality Analysis

+ Process improvement / transformation

+ Program management

+ Clinical workflow development and implementation

+ Strong oral and written communication skills

+ Presentation development

**Travel Requirement:**

0% - 25%

**_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._

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, 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, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

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.

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( _https://www.eeoc.gov/sites/default/files/migrated\_files/employers/poster\_screen\_reader\_optimized.pdf_ )

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For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

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Req ID: J190043

, Texas

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