VP Enhanced Community Care Management

highmarkhealth; Pittsburgh (Allegheny County); On-site; USD 180,000 - 270,000; Full time

Job summary

Highmark Health seeks the leader of the ECCM organization to guide strategic vision and growth across three new verticals: palliative care, complex care management and risk assessment. Reporting to the SVP, Home and Community Care, you will drive initiatives, optimize back‑office support, and collaborate with clinicians to advance value‑based care and improve patient outcomes in a large health system.

The role requires deep operational management, change leadership, and the ability to articulate

Qualifications

• 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

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.

Skills

Business Development

Building and Leading Teams

Business Strategy

Business Transformation

Strategic Planning

Strategic Relationship Building

Provider Relations

Organizational Change Management

Management

Education

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.

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)

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 r