Provider Integration Consultant

Job ID: J120157
Company: Highmark Inc
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at:

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Description

JOB SUMMARY

This job leads execution of the department's strategies, goals and objectives to continually monitor, manage and control large scale programs within Clinical Services with a focus on Provider Integration.  The incumbent will be charged with the development, coordination and management of matrixed projects to improve the health of our members while addressing care costs.  Accountable for assuring the analysis and outcomes reporting for all assigned programs. Under the direction of the senior leader, the role will collaborate with senior leadership across the enterprise (corporate, Highmark Health Plan, Allegheny Health Network, etc.) to develop short and long-range business plans to support the achievement of objectives of all assigned programs.  The incumbent serves as a integral member of the leadership team in the development of long term business plans (strategic and operating) that will ensure the success of the organization. 

ESSENTIAL RESPONSIBILITIES

  • Serve as a business line expert and provides management consultation to senior leadership as well as matrixed teams for Provider Integration programs, strategy development, product and benefit development, care management.  Manage the relationship with the client and all stakeholders.
  • Work independently to advance provider integration strategy to improve member outcomes and reduce medical costs for all lines of business. Develop and implement tactical plans to achieve strategic objectives. 
  • Review and synthesize literature and technical developments in the field of care management, value based programs, medical cost management especially in partnership with strategic provider partners.
  • Direct activities of program project teams through a matrixed reporting structure as needed to implement Clinical Services and Provider Integration strategies. Coordinate internal resources and third parties/vendors for execution of program implementation.  Develop program scope and objectives, involving all relevant stakeholders and ensuring technical team inclusion and all appropriate compliance and legal sign offs.  Develop a detailed program implementation plan to track program(s) progress as well as the creation and maintenance of comprehensive program documentation.  Ensure all programs are delivered on-time, within scope and within budget inclusive of program risk management and risk mitigation strategies and escalation of risk as appropriate.  Ensure sufficient resource availability and allocation.  Provide program status reports to senior leadership and all matrixed partners  
  • Other duties as assigned.

EDUCATION

Required

  • Bachelor's Degree in Business Administration/Management, Finance, Health Administration, Industrial Engineering, or a Health Care Related field

Substitutions

  • 6 years of professional work experience in a corporate/office setting can be substituted in lieu of a bachelor's degree

Preferred

  • Master's Degree in Business Administration/Management

EXPERIENCE

Required

  • 8+ years of Project Management experience
  • 1 - 3 years of Program Management experience
  • 1 - 3 years of experience working in the Healthcare Industry

Preferred

  • None

LICENSES AND CERTIFICATIONS

Required

  • None

Preferred

  • Registered Nurse
  • Project Management Professional (PMP)

SKILLS

Required

  • Budget Management
  • Building and Leading Teams
  • Leading Change
  • Program Evaluation
  • Program Management
  • Written & Oral Presentation Skills
  • Innovation
  • Research
  • Highly Organized

Preferred

  • None

Language (Other than English)

None 

Travel Required

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-Based

Teaches / trains others regularly

Frequently

Travel regularly from the office to various work sites or from site-to-site

Occasionally

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required 

Yes

Lifting: up to 10 pounds

Frequently

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 all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

Employee Referral Level 1

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.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

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