VP Enhanced Community Care Management

Highmark Health; Pittsburgh (Allegheny County); On-site; USD 180,000 - 240,000; Full time

Job summary

Highmark Health in Pittsburgh seeks the leader of the ECCM organization to execute the strategic vision and guide growth across three verticals: palliative care, complex care management, and risk assessment. You will drive initiatives to improve patient experience, lower cost of care, and achieve C2V targets for the segment.

The role entails strategy development and ongoing evolution, with deep operational management to ensure the verticals function efficiently and that back‑office functions

Qualifications

• Required Bachelor's of Nursing, Business Administration or Health Administration or relevant experience and/or education as determined by the company in lieu of bachelor's degree.
• Preferred Master's Degree, Doctor of Medicine (MD) or Advanced Practice Practitioner (APP) including NPs, CNS, CRNAs.

Responsibilities

• Involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.
• Plan, organize, staff, direct and control day-to-day operations; develop and implement policies and programs; may have budgetary responsibility and authority.
• Use an integrated provider-payor lens to create an operating model and deploy approaches to care redesign, value-based payment, care management and navigation, and financial value drivers.

Skills

Strategic leadership

Business development

Care management

Strategic planning

Relationship building

Organizational change management

Education

Bachelor's in Nursing or Health Administration

Master's Degree or MD/APP (preferred)

Job description

Company : Endorsed Job Description

JOB SUMMARY

The leader of the ECCM organization will be accountable to execute on the strategic vision and direction to transition the organization into its next phase of growth with accountability over three new verticals including palliative care, complex care management and a comprehensive risk assessment function. This role will be accountable for the implementation of key initiatives and approaches to enable and accelerate this transition that will drive an improved patient experience, lower cost of care and deliver on C2V targets for the Segment. The role will be responsible for the strategy development and ongoing strategy evolution along with deep operational management and expertise to ensure that the three verticals are functioning effectively and efficiently and that the back-office functions are supporting each of the verticals in the optimum way to drive value. This position would strategically enhance Highmark Health by building out resources and developing the value proposition to differentiate Highmark Health in the marketplace across a variety of content areas including care model redesign, operating model enhancement, care management and navigation, and financial value integration. This position reports to the SVP, Home and Community Care.

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. Use an integrated provider-payor lens to create an operating model and deploy unique approaches to a variety of content areas including care model redesign, value-based payment, care management and navigation, and financial value drivers. Collaborate with physicians and other clinicians to identify areas of opportunity for value improvement. Lead and design deployment of select initiatives that enable the transformation to value-based care. Ensure that all current clinical initiatives are meeting established objectives. Develops and implements policies and programs. Develop relationships that can help others understand and buy into the purpose of our value-based approach with an ability to articulate a compelling vision. Operationalize strategy by managing change to drive success and achievement in a heavily matrixed environment. Other duties as assigned or requested.

EXPERIENCE

Required 10-15 years of experience with Healthcare Industry 10-15 years of experience with Insurance Industry 8-10 years of experience with Leadership 8-10 years of experience with Management 10+ years of experience with Provider Relations 10+ years demonstrated Operational Excellence Preferred None

SKILLS

Business Development Building and Leading Teams Business Strategy Business Transformation Strategic Planning Strategic Relationship Building Provider Relations Organizational Change Management Management

EDUCATION

Required Bachelor's of Nursing, Business Administration or Health Administration or relevant experience and/or education as determined by the company in lieu of bachelor's degree. Preferred Master's Degree Doctor of Medicine (MD) or Advanced Practice Practitioner (APP) including Nurse Practitioners (NPs), Clinical Nurse Specialists (CNS), and Certified Registered Nurse Anesthetists (CRNAs)

LICENSES or CERTIFICATIONS

Required None Preferred None

Language (Other than English):

None

Travel Required:

0% to 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 any category protected by applicable federal, state, or local law. California Consumer Privacy Act Employees, Contractors, and Applicants Notice 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.