Senior Provider Cost Program Consultant

Company :

Highmark Health

Job Description : 

JOB SUMMARY 

* If living within a 50 mile radius of a Highmark location this will be a hybrid role with 3 days a week in office.

* This role will have a requirement to visit provider offices monthly or on an as needed basis.

This job works in collaboration with team members and leaders across the enterprise in support of the organization’s strategic objectives. The incumbent will be accountable for supporting the execution of cost programs across multiple different health systems, driving identification of cost program ideas and conducting necessary analysis in support of program ideas. This job is responsible for outcomes of providers contracted in the Organization's gain/risk share arrangements; this job is a highly skilled expert in practice transformation driving achievement of specific targets set in the individual gain/risk share contracts and is strategically focused on those data gaps that will result in the greatest ROI for the Organization. Further, in a matrix management environment, this job will collaborate with key internal/external stakeholders to optimize value from cost programs development and adoption. The incumbent may serve in various roles on projects, to include elements of problem-solving, strategy development, data analytics, communication, program inventory and assessment, and rationalization of the existing program portfolio and design. The incumbent will ensure viability of solutions through business model design, defining associated business processes, and developing operational plans, while considering economic factors. Collaborating closely with the provider transformation team, and internal/external stakeholders, the incumbent will assess programs, design, and execute analytical processes, develop technical content (requirements and user stories), support development of formal recommendations, and create documents to outline the processes for which provider organizations utilize or consume resources that support care delivery. Program design activities that the incumbent will drive include business modeling, documentation, management and oversight of end-to-end workflow process analysis and cost effectiveness, proper embedding of key performance indicators, and controls for regulatory, risk, and compliance considerations.

 
ESSENTIAL RESPONSIBILITIES 

• Support definition, scoping, and prioritization of efforts for cost program strategy and analysis within workstreams. Provide and support periodic reporting to leadership on assigned project activities.
• Drive and maintain strong working relationships across matrixed teams and stakeholder groups, continuing to promote and continually broaden the level of business knowledge and the impact of solutioning efforts.
• Lead planning sessions with internal and external leaders, clinician and business stakeholders to understand, document and design improvements to business models, processes, and systems to help prioritize and drive program design, development and execution
• Leverage a mix of frameworks and practices to deliver actionable insights and recommendations including: LEAN, Six Sigma, work simplification, organizational design, scenario planning, performance measurement, and process optimization.
• Participate and apply methods in Human-Centered Design, along with core business analysis frameworks, to help identify impacts to people, process, and technology solutions that are required to achieve solution objectives and support business case development.
• Identify root causes of problems and demonstrate the ability to development and make recommendations for solutions to mitigate root cause.
• Develop documentation, presentations, and communications that detail findings, articulate strategies, provide justification and make the case for solution approaches and priorities.
• Other duties as assigned or requested.

 

EXPERIENCE 

Required 

• 5 years of experience in practice management, hospital operations, ambulatory care, population health, or patient centered medical home with a background in budget management, revenue cycle, patient access, setting quality and efficiency metrics, accountable care organization development and support, and electronic health records.
• Experience may be from either health plan or provider employers.

 
Preferred 

• Familiarity with electronic health records and population health IT solutions, demonstrated experience working with health care data and analytics, experience in Lean and/or Six Sigma

 

SKILLS 

• Strong Facilitation skills
• Strong verbal and written communication skills
• Ability to use statistical assessment to quantify opportunities and to achieve process optimization
• Knowledge of the roles and deployment of change execution<