Highmark Health Performance Management Analyst in Pittsburgh, Pennsylvania
This job supports and assists the Director Medicaid Programs with the contractor (health plan) and overall management of the relationships between Gateway Health and the health plans as relating to the administrative services performed within a heavily regulated environment and provides support in initiatives for strategic planning. The incumbent will be accountable for strategic client relationship management, client account planning, managing client expectations, developing client solutions, assuring that the work performed by Gateway Health meets or exceeds contract and service level obligations, as well as supporting strategic planning and the Director Medicaid Programs as a subject matter expert for new and ongoing initiatives. Serves as an internal liaison to implementation and operations areas for the health plan. Provides analytical and project documentation support that enables project and business leadership teams to: 1) isolate business issues; 2) help design and execute analytics for studying business issues (market research, scenario planning, forecasting, market share, profitability, etc.); 3) develop technical content (competitive intelligence, market trend analysis); 4) support development of formal recommendations to Director Medicaid Programs and Sr ; 5) help create document components (go-to-market or operational strategies, etc.) that inform critical strategic issues and decisions.
Support the Director of Medicaid Programs in planning and organizing theday-to-dayoperationsofthedepartment. Developand/or lead the implementation of policiesand programsasnecessary.
Maintain regular and timely communication channels with Direct Medicaid Programs and matrix partners and serve as the regulatory liaison between the health plan and Gateway's operations and health services teams to manage client expectations, quickly resolve operational issues, and ensure successful implementation of actions needed to resolve issues and/or improve business functions.
Manage relationships, at all levels, with clients and consultants by creating valued business partnerships, demonstrating business acumen and cultivating a proactive partnership.
Monitor and document the scope of work required by the contract and initiate change management process, as needed.
Provide project support and communicateoperational/ programmatic changes, when needed. Serve as subject matter expert (resource) to staff and stakeholders on membership, growth and operational strategy issues. Communicate effectively, consistently and frequently with health plan. Ensure prompt response to ad-hoc health plan issues, questions and requests.
Provide oversight for account management projects as well as for new and ongoing requirements. Apply a broad knowledge of concepts and principles to develop analytical frameworks, approach and methodology best practices to analyze complex strategy issues, often applying ingenuity and originality to develop unique solutions.
Assist with the timely delivery of all required reporting. This includes operational performance reports and applicable reports as outlined in the MCO contract and business associate agreement.Continually monitor Gateway Health's performance against requirements of the contract. Notify Gateway Health executive management of escalated client concerns, continued negative feedback or 'red flags' related to administrative services performed.
Conduct analysis and oversight of design, development, modification, adaptation, and implementation of solutions for improvement of short-term and long-term clinical and operational excellence.
Other duties as assigned or requested.
- Bachelor's Degree in Business, Public Relations, Economics or other related area
3 - 5 years in any combination of Healthcare, Project Management, Communications or related area
1 year in a Client Relations role
Background that includes positions in a Medicaid Managed Care organization or ASO organization
Experience in Account Manager position or similar role
LICENSES AND CERTIFICATIONS
Strong knowledge of state and federal managed care regulations and working with government contracts
Excellent communication skills including written, verbal and interpersonal skills. Reliable, self-confident and enthusiastic
Ability to work in a collaborative oversight role with internal and external stakeholders and subcontractors
Demonstrated experience in prioritizing and managing multiple tasks and priorities
Ability to solve practical problems and deal with situations where only limited standardization exists
Detail oriented with strong organizational skills
Persistent personality with strong follow-up on responsibilities and tasks
Languages (Other than English)
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Teaches/Trains others regularly
Travels regularly from the office to various work sites or from site-to-site
Works primarily out-of-the office selling products/services (Sales employees)
Does Not Apply
Physical Work Site Required
Lifting: up to 10 pounds
Does Not Apply
Lifting: 10 to 25 pounds
Does Not Apply
Lifting: 25 to 50 pounds
Does Not Apply
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.
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity