Experience Inc. Jobs

Company :

Helion

Job Description :

JOB SUMMARY

This job develops and executes a comprehensive strategy to apply the HCS network management model to new verticals or new markets, or refine and evolve strategies in existing markets to meet HCS goals. Performs, refines, and tracks market maturity using a combination of quantitative and qualitative measures to ascertain and pace market strategy to ensure efficacy and performance. Tracks and reports out on performance of all network management levers, including network design and reimbursement strategies. Effectively engages with internal and external stakeholders to ensure alignment with broad organizational strategies within and outside of HCS. Communicates and partners with operational and account leads to ensure timely and effective implementation.

ESSENTIAL RESPONSIBILITIES

• Perform standardized market maturity assessments by leveraging various internal and external data sources or technologies.Make recommendations for refinement or evolution of market maturity assessment to increase effectiveness or efficiency.

• Develop strategies to apply the HCS network management levers, including network design and reimbursement, to new or existing markets in line with opportunity and maturity assessment as well as SLA and performance targets.Make and vet recommendations relative to anticipated launch point (e.g. phase of the reimbursement roadmap to risk).Ensure strategic assumptions about market conditions are transparent.

• Identify pacing for applications of each network management lever for greater degrees of maturity and effectiveness in a given market.Track market performance relative to strategic assumptions and identify pivot points where appropriate.

• Identify the appropriate application of the HCS network management model to new verticals/provider types with immediate and long-term cost optimization and commercial potential.Guide the development and test and learn phase of these applications.

• Partner with internal and external stakeholders, including governance committees, to ensure alignment of market strategies with broader strategic direction.Manage relationships with business line leads.

• Partner with implementation and operations leads to ensure seamless transition from strategy to execution and effective progression of the market strategy.

• Other duties as assigned or requested.

EDUCATION

Required

• Bachelor's degree in Business, Healthcare Administration, or related field, or relevant experience and/or education as determined by the company in lieu of bachelor's degree

Preferred

• Master's degree in Business, Healthcare Administration, or related field

EXPERIENCE

Required

• 3 years in Healthcare OR 3 years consulting

• 1 year in Strategic Planning

Preferred

• 3 years in Business Intelligence

• 1 year of Client Management

• 1 year with Innovation

LICENSES or CERTIFICATIONS

Required

• None

Preferred

• None

SKILLS

• Excellent written and verbal communication skills; ability to communicate effectively both individually and in groups

• General experience of other MS Office applications and contract/revenue management software

• Broad experience in PAC price drivers and contracting methods

• Proficient in external customer negotiations of contractual language; able to assess and interpret risk, contract language nuances, operational and process-oriented situations and the impacts of each

• Analysis of business problems/needs

• Analytical and logical reasoning/thinking

• Business case justification, Conflict management, Health insurance, Excellent multi-tasker, Innovation, Presentation delivery, Influence and persuasion, Strategy management

Language (Other than English):

None

Travel Requirement:

Occasionally

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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Req ID: J247676