Director Reimbursement Design & Market Evaluation

Job Opportunity at Highmark Inc

Job Summary : This job supports the matrixed strategic design and analytical approach to reimbursement. To be successful, the incumbent will work closely with stakeholders across the enterprise in the development and implementation of an integrated roadmap for the introduction and delivery of new and innovative reimbursement models across all of Highmark's markets and lines of business. This will require aligning new models to the health plan's strategic objectives based on a deep understanding of innovation and industry trends in both the commercial and government lines of business. This team will be responsible for supporting development and maintaining models that will drive both the return on investment and other decisions on the payer partnership constructs. These new approaches require new operational capabilities, and this team is responsible for identifying those gaps, building requirements to drive the development of new capabilities, and tying them to Highmark's strategic capability roadmap. They will need to work effectively across teams to inform and influence change to drive adoption and ROI realization. Critical partners include Advanced Analytics, Contracting, Market and Provider support teams, Actuary, Finance, Highmark Health Solutions, Health Plan Operations.

Essential Responsibilities :

• Perform management responsibilities to include, but are not limited to : involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
• Develop the overall conceptualization, strategy alignment, financial models, and high-level design of new reimbursement models for both government and private payers.
• Work in a Health Economist approach to build and maintain analytical models that performs evaluation of reimbursement models.
• Develop and maintains strategic provider relationships to understand the current health care delivery state, readiness for change, test value based programming concepts and components, identify key partners, identify and proactively communicate market transformation concepts with provider and professional advocacy societies and key thought leaders.
• Other duties as assigned or requested.

Education :

Experience :

Skills :

Physical, Mental Demands and Working Conditions :

Pay Range Minimum : $126,400.00 Pay Range Maximum : $236,000.00

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