Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This job manages the enterprise wide Medicare/Medicaid Quality Performance programs which provide oversight and guidance for the enterprise portfolio of programs and projects with the oversight from the Director. Works collaboratively with multiple stakeholders and various cross-functional teams, locations and departments to improve Stars and/or Quality Rating (inclusive of HEDIS, CAHPS, HOS, and state-specific performance measures) outcomes for both Medicare and Medicaid products. Manages efforts to perform analysis of enterprise-wide practices to identify opportunities for improvement. Designs, implements and executes strategies and work with cross-functional clinical, pharmaceutical, operational, IT and quality performance improvement teams to ensure overall goals of the organization are met and to optimize outcomes. Collaborates with the company’s Medicare/Medicaid leadership committees to ensure that new programs and projects are aligned to divisional and corporate strategic objectives and direction. The incumbent maintains the Medicare Stars and/or Medicaid Program management processes, procedures and best practices. The incumbent escalates cross-portfolio dependencies, project risks, and items for management attention to the executive leadership group.

ESSENTIAL RESPONSIBILITIES

• Perform management responsibilities including, but 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.

• Assist Director in the planning, design, development and implementation of the Quality Performance Management Department strategic plan based upon the strategic initiatives and direction of the organization.

• Monitor and report, on a regular basis, the status of the Quality Performance Management Department strategic plan, initiatives and activities. Present strategic plan information within the Highmark Wholecare organization, and externally to Highmark Wholecare’s committees, regulatory bodies, professional organizations, business partners, delegates, and vendors.

• Oversee organization-wide quality performance improvement process within Highmark Wholecare Health Plan, which includes HEDIS, CMS Stars, Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Health Outcomes Survey (HOS).

• Collaborate across enterprise to analyze HEDIS and Stars performance in order to develop, implement and monitor interventions and activities to improve quality performance and revenue.

• Manage the CAHPS and HOS processes, including vendor selection, management, reporting, analysis and driving organization-wide change based on the results and opportunities identified.

• Assist in the planning and preparations for external audits and surveys, including but not limited to NCQA Accreditation Surveys, CMS, and state Medicaid regulators. Evaluates, recommends and implements processes and programs as necessary to maintain NCQA compliance. Assess current processes and implements Medicaid and/or Medicare performance management improvement programs, as mandated by external regulators or as needed by enterprise

• Other duties as assigned.

EDUCATION

Required

• Bachelor's Degree in Business Administration/Management or Health Care Related field

Substitutions

• High School Diploma with 6 years of experience

Preferred

• Master's Degree in Business Administration/Management or Health Care Related field

EXPERIENCE

Required

• 3 - 5 years of Quality Improvement experience

• 1 - 3 years of Project Management experience

• 1 - 3 years of Process Design experience

• 1 - 3 years of Process Improvement experience

Preferred

• 3 - 5 years of Strategic Planning experience

• 1 - 3 years of Operational Excellence experience

• 1 - 3 years of Medicare experience

• 1 - 3 years of Medicaid experience

• 1 - 3 years of Management experience

LICENSES OR CERTIFICATIONS

Required

• None

Preferred

• None

SKILLS

• Analytical Skills

• Performance Improvement

• Project Management

• Collaboration

• Written & Oral Presentation Skills

• Team Leadership

• Strategic Thinking

• Budget Management

• Healthcare Industry

• Vendor Management

Languages (other than English)

None

Travel Required

0% to 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office Based

Teaches / trains others regularly

Frequently

Travel regularly from the office to various work sites or from site-to-site

Occasionally

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Yes

Lifting: up to 10 pounds

Occasionally

Lifting: 10 to 25 pounds

Rarely

Lifting: 25 to 50pounds

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 position 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.

Pay Range Minimum:

$78,900.00

Pay Range Maximum:

$147,500.00

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

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.

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )

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For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

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Req ID: J254932