Company :
Highmark Health
Job Description :
JOB SUMMARY
The Market Executive is responsible for the leading the delivery system-related performance and strategies in their responsible market(s). This includes overseeing provider partnerships and developing and executing on strategic and operational plans related to the provider network, delivery of care, population health management and cost of care, and growth objectives for the market. This role will work in close partnership with the SVP of Markets to establish strategies in the market that support growth and financial objectives for the various insurance segments sold. The Market Executive will work closely with respective Highmark segment (e.g., Government, commercial) leaders to understand the performance and network needs in the market and coordinate the strategy development and building the networks to deliver that performance across key metrics including quality, risk revenue, affordability, access, customer and clinician experience, and equity. The Market Executive is a key driver of transformational change, including the market’s financial and operational performance, as well as organizational culture, talent, and leadership. As such, this role will be a face to the provider community and will need to have experience working in leadership roles inside delivery system entities as well as the ability to influence and work highly collaboratively with both internal and external executives.
ESSENTIAL RESPONSIBILITIES
- Lead the delivery of key financial and operating targets in the responsible market(s), with a dedicated commitment to optimize revenues, maintain cost effective operations, and provide continuous performance improvement. Accountable for meeting targets in areas of Risk Revenue, Quality/stars, affordability, reimbursement/contracting trend, network alignment.
- Alongside the segment partners, ensure coordination of all market-performance related levers to meet quality, experience, and affordability goals.
- Lead the development and implementation of a holistic market approach which includes market strategy and structure, retention and profitability, partnership growth, and development of accountability frameworks grounded in KPIs.
- Actively lead the transformational strategies with the strategic partners in the market, pulling on the others in the organization for delivery. This includes strategies such as: value-based and alternative payment models, and MLR and risk models to ensure appropriate program results; growth-related levers including care alignment, attributed membership and wallet share; care model improvements where appropriate; solutions to improve member’s health and lower cost of care; new business and legal structures and / or collaboration models to further economic ties; and, provider administration simplification techniques to create efficiency between payor and provider.
- Engage physician and system leadership to create a culture of alignment and further develop and drive an effective clinical integration strategy, which positions Highmark Health and the provider partner systems as the preeminent brand in the market. Work with physician aggregators to ensure appropriate structures and effective physician management of populations resultant in economic returns associated with that management and lower cost of care for members.
- Attract, retain, and develop top talent, focusing on succession planning and the cultivation of a best-in-class team. Cultivate an organizational culture that drives workforce engagement focused on innovation, learning, and continuous improvement.
- Oversee the full relationships with all parts of the delivery system, including guiding contract negotiations and handling operational issues. Responsible for ensuring that provider relationship goals are set and met every year. Working with data and analytic teams, identify opportunities for improvement in KPIs not meeting expectations as well as trends emerging in the market requiring actions. Trend may include increases in utilization, total care costs, potential new asset development, or other provider site of care changes.
- Along with Data and Analytics, work in partnership with segment leads and with health plan partners to identify mutual synergies to address profitability resulting from cost reduction strategies in PMPM including its drivers in disease-based management, care management, utilization management, and risk coding opportunities as well as pharmacy strategies.
- Represent Highmark to appropriate market-based constituencies including provider health system C-suites, vendors, and health plan stakeholders. Represent Highmark Health in the industry for our market approach with provider, producers, customers, regulators, and other community stakeholders.
EDUCATION
Required
- Bachelor's degree in business or health
Substitutions
Preferred
- Master's degree in business or health
EXPERIENCE
Required
- 7+ years in healthcare Industry, with some portion of that as part of a delivery system entity
- 7+ years in a management or leadership role
- 5 years in project management, leadership, or strategic planning
- Strong analytic background
Preferred
- Clinical operations experience
- Understanding and managing provider performance, specifically in hospitals, physician practices or health systems.
- Experience working within a matrixed organization.
- Business process redesign, change management, or program development.
- Experience in complex program management, MSO capability development or operation improvement.
- Management consulting
LICENSES or CERTIFICATIONS
Required
Preferred
SKILLS
- Capable of managing provider leadership relationships as a Highmark executive.
- Broad application of principles, theories, and concepts in strategic thinking.
- Strong PC skills (MS Office, PowerPoint, Excel).
- Breadth of knowledge related to Healthcare industry trends.
- Demonstrated executive presence with outstanding communication skills (verbal, written, and presentation) as well as excellent negotiation, networking, and interpersonal operating and finance skills.
- Ability to work effectively across many matrixed functions and with executive leadership teams.
- Presentation skills and a proven ability to communicate detailed information to healthcare executives, provider leaders and physicians.
- Strong project management skills including the ability to manage multiple projects and meet concurrent deadlines.
Language (Other than English)
None
TRAVEL REQUIREMENTS:
25% - 50%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office-based
Teaches / trains others regularly
Occasionally
Travel regularly 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
Yes
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 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 requirements.
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, age, 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, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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