VP Ancillary Provider Strategy & Management

Highmark Health; Pittsburgh (Allegheny County); On-site; USD 95,000 - 150,000; Full time

Job summary

Highmark Health in Pittsburgh seeks a senior leader to manage provider networks across markets, focusing on ancillary networks and reimbursement model innovation to control costs and improve member experiences.

The role guides contracting strategies with Product, Clinical, and Reimbursement teams, overseeing signatory authority and collaboration with internal stakeholders to drive value-based care initiatives.

Qualifications

• Bachelor’s degree and 7 years of experience in healthcare/ managed care in a management role.
• 7 years of experience in provider contracting, benefit design, medical management, or healthcare administration.
• Excellent written and verbal communication skills.
• Leadership, teamwork, strategic thinking, influencing, negotiating skills, and operations execution.

Responsibilities

• Oversee contract negotiations and network management programs for ancillary providers and national/multi-market providers.
• Own and manage contract signatory authority for such provider contracts.
• Establish benchmarks and monitor parameters to ensure product and service competitiveness.
• Develop and implement pay-for-value contracts across markets.
• Collaborate on a network management strategy for post-acute care services, including SNF and Home Health.
• Represent Highmark Health to internal stakeholders and external providers and regulators.

Skills

Bachelor's degree

Leadership

Negotiation

Communication

Strategic thinking

Influencing

Operations

Healthcare experience

Education

Bachelor's degree in healthcare/related field

Job description

Company : Highmark Inc. Job Description

GENERAL OVERVIEW

Lead and manage the development and maintenance of Highmark’s various provider networks for all lines of business and all market segments, with emphasis and ownership of the ancillary networks and multi-market providers. Develop and implement new reimbursement and care delivery models that result in cost trend control, higher care quality, appropriate access, and better member experiences. Create and implement innovative programs and services that integrate contracting strategies with Product, Clinical, and Reimbursement strategies.

ESSENTIAL RESPONSIBILITIES

Oversee contract negotiations and network management programs for ancillary providers and national/multi-market providers. Own and manage contract signatory authority for such provider contracts. Establish appropriate benchmarks and monitor parameters to ensure product and service competitiveness. Facilitate creation and/or adoption of innovative products and services to meet market demands. Develop and implement pay-for-value contracts for a variety of ancillary providers across all markets. Provide oversight for the support of market-based provider initiatives including communications, contract issue resolution, C2V initiatives and high-performance network management. Collaborate with Home & Community Services / Helion to develop and implement a comprehensive network management strategy for post-acute care services with an emphasis on Skilled Nursing, Home Health, Inpatient Rehabilitation, and Long-term Acute Care. Lead and manage successful relationships with all internal stakeholders, particularly, Market-segment leadership, Reimbursement, Product, Payment Innovation, Medical Management, and Sales. Represent Highmark and the Provider Services division to external stakeholders, including Providers, Accounts, Regulatory entities, BCBSA, etc. Other duties as assigned or requested.

QUALIFICATIONS

Minimum: Bachelor’s degree 7 years of experience in healthcare and/or managed care in a management role 7 years of experience in provider contracting, benefit design, medical management, or healthcare administration Knowledge, Skills and Abilities : Excellent written and verbal communication skills Excellent presentation skills Strength in leadership and teamwork, strategic thinking, influencing skills, negotiating skills, and operations execution.

SCOPE OF RESPONSIBILITY

Does this role supervise/manage other employees? Yes If yes, indicate the number of direct reports: 1

WORK ENVIRONMENT

Is Travel Required? Yes

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.

EEO/DEI

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.

ABOUT US

Highmark Health is a national, blended health organization that includes one of America’s largest Blue Cross Blue Shield insurers and a growing regional hospital and physician network. Based in Pittsburgh, Pa., Highmark Health’s 35,000 employees serve millions of customers nationwide through the nonprofit organization’s affiliated businesses, which include Highmark Inc., Allegheny Health Network, HM Insurance Group, United Concordia Dental, HM Health Solutions and HM Home & Community Services. Highmark Health’s businesses proudly serve a broad spectrum of health-related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions.