Provider Transformation Specialist

2 days ago


Harrisburg, Pennsylvania, United States Highmark Health Full time
Job Summary

This role is responsible for driving outcomes for providers contracted in Highmark Health's gain/risk share arrangements. The successful candidate will be a highly skilled expert in practice transformation, with a focus on achieving specific targets set in individual gain/risk share contracts.

Key Responsibilities
  • Support providers in maximizing quality and ROI through data analysis and decision-making.
  • Develop process interventions based on practice-level data, trends, and opportunities.
  • Collaborate with the value-based reimbursement team, provider relations, and analytics to provide support for providers with gain/risk share contracts.
  • Identify process improvement gaps in workflow and develop individualized plans to remedy.
  • Provide educational and training sessions to support provider transformation.
  • Develop and maintain relationships with specialists and/or hospital resources for providers employed in multi-specialty groups or health systems.
Requirements
  • Bachelor's Degree in Business, Finance, or Healthcare related field and an RN license or Bachelor's Degree in Nursing.
  • 5 years of experience in practice transformation, including population health, ambulatory care setting quality and efficiency metrics, accountable care organization development and support, patient-centered medical home, and electronic health records.
Preferred Qualifications
  • Familiarity with electronic health records and population health IT solutions.
  • Demonstrated experience working with healthcare data and analytics.
  • Experience in Lean, Six Sigma, risk management, contract management, finance management.
Skills
  • Effective issue resolution and problem-solving skills.
  • Knowledge of corporate strategies, policy, and scope of authority.
  • Integrity, professionalism, diplomacy, and conflict management skills.
  • Deep understanding of primary care practice operations and workflow.
  • Superior written and verbal communication skills and listening skills.


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