VP Reimbursement, Provider & Network Programs

Highmark Inc. Job Posting

This role is accountable for any program or strategic tactic to drive provider performance in the domains of reimbursement and network programs. Specifically, the incumbent will lead the strategy and creation of value-based reimbursement (VBR) & risk programs, as well as the overall provider inventive and payment strategy. The role also leads the strategy and creation of provider network designs and programs.

The incumbent is responsible for understanding regulatory trends and competitive advantages / disadvantages when formulating strategies. Accountable in any program design for the full business case including implementation strategy and working with rest of organization to ensure resources, technology, communications, training are in place. Programs should be ready to operationalize once transitioned. The incumbent will develop market rollout plans and roadmaps for the programs and will tie in enterprise and provider strategy into the creation of these programs.

Essential Responsibilities

• Responsible for the strategy and creation of provider reimbursement programs to position the organization competitively based on market trends and forecasting.
• Lead the team that builds, updates, and maintains the multi-year roadmap for reimbursement program evolution. This includes custom VBR programs established with strategic provider partners, joint economic models, and standard models such as True Performance and Quality Blue.
• Responsible for creating a holistic incentive and payment strategy, including RPM, STARS, and Quality programs. Gain approval from internal stakeholders, and communicate the support and requirements needed across the enterprise to operationalize.
• Develop and maintain HPN network design strategy, translating product / segment needs to provider and market executives.
• Oversee development of tools and analytics needed for identification, inclusion, and management of network participants. Oversee design and development of Network performance scorecards.
• Responsible for ensuring alignment strategy and tactical playbook drives volume to preferred networks in each market, and responsible for working with market executive function to set steerage goals.
• Oversee strategy for disruption and mitigation planning.
• 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.
• Other duties as assigned or requested.

Experience

Required

Preferred

Education

Required

Substitutions

Preferred

Licenses or Certifications

Required

Preferred

Language (Other than English) : None

Travel Requirement : 0% - 25%

Physical, Mental Demands and Working Conditions

Position Type Office- or Remote-based

Teaches / trains others Occasionally

Travel 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 No

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.

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