Highmark Health Practice Leader in Pittsburgh, Pennsylvania

Description

JOB SUMMARY

This job drives service delivery and business management for a given office (Front Office, Operations) of the Consulting Services division of HM Health Solutions. Builds out and advances their given Practice area to implement capabilities and solutions for multiple HMHS customers (existing and future) to achieve revenue and profitability targets.

The incumbent executes approaches that facilitate and drive adoption of the Enterprise Health Solutions capabilities by HMHS Customers, within a highly complex matrix environment. Serves as a trusted adviser to the Customer’s management team, drives attainment of value through collaborative and effective advisory management services, serving in or architecting co-management arrangements with customers, and providing innovative adoption-oriented (internal functions and market-facing) approaches with customers.

The incumbent designs and implements complex and transformation changes at a client site, building methods and a consulting workforce that is viewed as top tier in the industry to develop and implement solutions for a diverse client base of customers. An additional critical role will be to serve as a visible and demanding advocate for the EHS in strategic planning and related governance processes with the Highmark Health Plan customer and other ASP clients.

The incumbent is a significant contributor and leader of the platform planning processes to make sure market needs are exceeded/met and that HMHS platforms are viewed favorably in the market place and with our customer base.Conducts direct engagement in HMHS business development efforts to cultivate new partnership opportunities with other prospective customers by representing HMHS in executive level presentations, business case development, evaluating other Plans assets and business value to Highmark and other support activities to grow additional scale.

the incumbent will likely have one of five areas of accountability:

  • Provider Management Focus is defined as those people, process and technology solutions focused on Provider Pricing, Credentialing, Payment Innovation and Contract Management techniques as it relates to both the Payer and Provider systems in an integrated and none integrated delivery setting.

  • Clinical & Government Programs is defined as those people, process and technology solutions focused on Care, Disease and Utilization Management along with Health and Wellness as it relates to both the Payer and Provider systems in an integrated and non-integrated delivery setting. In addition, those areas & programs related to Medicaid, Medicare, Mandates and HCR would be a focus of this leader.

  • Front Office is defined as those people, process and technology solutions focused on Sales, Product Management, Benefit Management and Member/Group/Broker channel management as it relates to both the Payer and Provider systems in an integrated and non integrated delivery setting.

  • Operations is defined as those people, process and technology solutions focused on Claims Processing, Service, Enrollment, Document Generation, Disbursement, Billing, Spending Account etc management as it relates to both the Payer and Provider systems in an integrated and none integrated delivery setting. Some of these arrangements will be in an Application Support Model (ASP) while others will be in a Business Processing Arrangement (BPO) with the Highmark Health Plan.

  • Enterprise/Corporate is defined as those people, process and technology solutions focused on Corporate Systems like Work Day, Oracle/PeopleSoft, Integrated Delivery Focused platforms as they are supported by HMHMS and/or utilized by ASP Clients as it relates to both the Payor and Provider systems in an integrated and non integrated delivery setting.

ESSENTIAL RESPONSIBILITIES

  • Build out a strong consulting workforce to staff the development, design and implementation of complex, transformation changes at a client site. These leaders are accountable to build and grow a robust community of practice.

  • Build tools and methods and a consulting workforce that is viewed as top tier in the industry to develop and implement solutions for a diverse client base.

  • Effective manage team member utilization, program achievement along with effective hiring, growth and development of consultants and consulting managers in the organization.

  • Drives delivery monitoring and management of multiple complex projects and programs that span portions of the application.The portfolio of projects under direct control range from multiple $500K to large multi year efforts that are sometimes greater than $90M.The average annual portfolio would be $30M - $60M dollars and can go higher when implementing a large client.

  • Accountable for directing multiple projects simultaneously and teams with the Product organization on build activities.

  • Maintain the relationship with the customer on all elements of what is being built during the life cycle.

  • Provide strategic oversight and direction to Practice Leadership (Principals and below) in achieving multi-million dollar program delivery outcomes on time, on schedule, and within budget.

  • Lead or assist EHS customers to create and implement internal and external adoption strategies and plans for a complex portfolio of products and programs to achieve desired outcomes.

  • Position HMHS’s product/service offerings in manner appropriate to each customer.

  • May provide advice to EHS customer in negotiating and managing strategic vendor relationships including agencies, spokespeople, and Consultants as it relates to customer’s use and application of EHS’s capabilities.

  • Develop and deliver insightful presentations and strategies to the business unit and executive committee where appropriate.

  • Develop strong market intelligence and relationships required to influence EHS Customers’ internal planning processes to ensure that future capabilities are surfaced and considered responsive to the 1-3 year advanced market needs of EHS customers.

  • Other duties as assigned or requested.

EDUCATION

Required

  • Bachelor's Degree

Preferred

  • MBA or other Masters degree in related discipline

EXPERIENCE

Required

  • 10-20 years of progressive management experience which includes: ◦Deep, proven expertise in multi-functional management, strategy development and/or integrated tactical implementation for complex, large initiatives.

  • Developing business cases and/or comprehensive presentations to executive- and board-level leaders

Preferred

  • Prior deep consulting and/or practice leadership experience

  • Prior management experience

  • Proven success in launching or executing large-scale and change-oriented initiatives, new products/services or other high-visibility or high-risk initiatives.

  • Understanding of software product / capability management, life-cycle and build processes

  • Understanding of consultative selling practices.

  • Recognized personal expertise by BCBSA or other industry forums

  • Experience managing a community of practice or consulting practice.

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.

REQNUMBER: J120128

Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity