Market Director

JOB SUMMARY

This job is responsible for the administration and maintenance of positive, collegial relationships between the corporation and the provider and health system community. The incumbent is responsible for engaging entities on performance-related activities such as Value-Based Reimbursement (V ), Stars and Risk capture, as well as other organizational solutions as appropriate. Additionally, they will keep up with market trends and industry dynamics, including at both a macro and micro level (examples of micro level include changes/expansion of services provided by physicians), and current technologies to ensure the company is ensuring optimum outcomes for both the provider and corporation.

Company

Highmark Inc.

This position is based in West Virginia. Candidates must reside within the state and be able to travel to provider locations throughout West Virginia. This role can be hybrid or remote. Candidates who are within 50 miles of an office will be required to be onsite 3 days a week.

ESSENTIAL RESPONSIBILITIES

• Identify and cultivate relationships with providers in value-based arrangements outside of the Top 40 provider entities. Establish key contacts in all critical areas of the identified provider entity/system. Oversee administration of critical and timely communication to providers through ongoing personal contacts, site visits, regional communication sessions, meetings with professional organizations to communicate initiatives and changes.

• In partnership with the Market Executive, conduct analysis and make data driven decisions to ensure we are getting appropriate returns on investments for initiatives, increasing quality, lowering cost, and increasing patient satisfaction. Work with actuary and informatics teams to develop population health tools/reports, care alignment reports, and other resources that will produce value for Highmark, the provider partner, and the member.

• Utilize data to make informed decisions, negotiation skills to achieve desired results, and project management skills to ensure successful execution of commitments. Work collaboratively across the internal enterprise, establish networks to support provider engagement.

• Promote efficient communications in close partnership with Provider Engagement including coordination of provider advisory groups, forums and events hosted by Highmark.

• Identify, develop, and grow provider relationships through collaboration that will form the glide path for future transformation in care delivery and reimbursement models. This requires interfacing with various departments in the organization as well as vendor teams.

• Other duties as assigned or requested.

EXPERIENCE

Required

• 7 years of experience in the health care/health insurance industry to include value-based care and provider relations/network management

• Experience with data analytics and trending

Preferred

• Experience working in provider or health system administrative or clinical role

SKILLS

• Strong interpersonal organizational and analytical skills

• Superior communication (written and oral), teamwork, organizational and leadership skills

• Strong understanding of health care quality programs such as STARS, HEDIS

• Understanding dynamics of matrix organization

EDUCATION

Required

• Bachelor’s degree or relevant experience and/or education as determined by the company in lieu of bachelor's degree.

Preferred

• Master's degree.

LICENSES or CERTIFICATIONS

Required

• None

Preferred

• None

Language (Other Than English)

None

Travel Requirement

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type:
Office- or Remote-based;
Teaches / trains others:
Occasionally;
Travel from the office to various work sites or from site-to-site:
Rarely;
Works primarily out-of-the office selling products/services (sales employees):
Never;
Physical work site required:
No;
Lifting up to 10 pounds:
Constantly;
Lifting 10 to 25 pounds:
Occasionally;
Lifting 25 to 50 pounds:
Rarely;

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…