Value-Based Reimbursement Strategist

1 month ago


Dover, Delaware, United States Highmark Health Full time
Job Summary

This role is responsible for driving key strategic initiatives for the Markets and Provider Transformation Organization, supporting matrixed teams that engage providers enrolled in Highmark Health's value-based reimbursement programs and continuous improvement models.

The incumbent will play a central role in developing and executing strategies for transformation of workflows, resulting in outstanding performance in Highmark Health's value-based reimbursement programs, ensuring that ROI targets are met or exceeded.

This position collaborates with various teams within data analytics and infrastructure to support the creation, optimization, and maintenance of self-service resources for providers, entities, and health systems within these programs.

Key Responsibilities
  • Participate in the development of strategic plans for the Enterprise and Markets and Provider Transformation, focusing on Highmark Health's value-based reimbursement programs and continuous improvement models.
  • Lead or support key strategic initiatives across Enterprise and Markets and Provider Transformation, including team leadership, problem-solving, data analysis, project management, communication, implementation, and provider and/or provider-facing team education support.
  • Serve as a subject matter expert, working in concert with provider-facing teams to explain new programs and results to key provider partners as needed.
  • Collaborate on product development and the creation, optimization, and maintenance of a self-service platform for providers, entities, and health systems within Highmark Health's value-based reimbursement programs.
  • Provide actionable opportunities in provider transformation aimed at high-quality, cost-effective care while improving patient outcomes.
Requirements
  • 5 years of work experience in the primary care and ambulatory care environment, healthcare insurance industry, healthcare administration in primary care, or healthcare consulting in primary care or population health management.
  • 3 years of experience in data analysis, interpretation, and outcomes strategic plan development.
  • 1 year of experience with Medicare STARS, Medicaid HEDIS, risk revenue value streams, and population health management.
Preferred Qualifications
  • 7 years of experience in managed care, primary care management, or other clinical setting.
  • Experience in Lean, Six Sigma, TQI, TQC, or other quality management certification.
  • Experience in health plan provider network performance management, population health management, continuous improvement, or provider engagement models.
  • Experience influencing change in complex organizational systems.


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