Get alerts to your inbox about new open jobs that are similar to this one.
No spam. No ads. Unsubscribe anytime.
A healthcare insurance company focused on delivering innovative solutions and improving customer experience.
Highmark Health
JOB SUMMARY
*This is a hybrid role with 3 days onsite in our DE office. Must reside in the Southeastern PA/DE Highmark footprint.
This job is directly responsible for the value creation, impact and cost control, and fiscal/ROI targets as set by the Organization. This includes revenue stream outcomes and engagement of primary care providers (PCP) and facilities enrolled in the Organization’s value based reimbursement programs, clinical care models, and continuous improvement models. The incumbent applies subject matter expertise in clinical pharmacy, pharmacy formulary, pharmacy benefit design, pharmacy policy, medical drug policy, therapeutic alternatives, medication adherence strategies, Medication Therapy Management, utilization management, immunizations, specialty pharmacy, Medicare Stars, and Medicaid HEDIS to strategies designed to promote the Organization’s value based reimbursement PCP and facility programs. The incumbent acts as a highly skilled subject matter expert (SME) in the Organization's value based reimbursement PCP and facility programs providing strategic, hands-on, office based support to PCPs and facilities for analysis of performance in quality, cost, and utilization scores, identifies opportunities for improvement in value creation, cost control and utilization, performance, and develops strategic plans in collaboration with PCPs and facilities and the interdepartmental teams for transformation of workflows resulting in outstanding performance in the Organization's value based reimbursement PCP and facility program(s), ensuring that ROI targets as set by the Organization are met or exceeded. Further, in a matrix management environment, the incumbent collaborative works with other functions in the provider area, data analytics, pharmacy team, and key internal/external stakeholders to provide the most appropriate support to the PCP's based upon data analysis and dashboard reports.
ESSENTIAL RESPONSIBILITIES
EDUCATION
Required
Substitutions
Preferred
or
EXPERIENCE
Required
Preferred (any one of the following)
LICENSES AND CERTIFICATIONS
Required
Preferred
SKILLS
Language (Other than English)
None
Travel Required
50% - 75%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office-Based
Teaches / trains others regularly
Constantly
Travel regularly from the office to various work sites or from site-to-site
Frequently
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
Occasionally
Lifting: 25 to 50 pounds
Occasionally
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.
EEO is The Law
Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ([https://www.eeoc.gov/sites/default/files/migrated%5Ffiles/employers/poster%5Fscreen%5Freader%5Foptimized.pdf>)
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
🇺🇸Added 2h ago
Board Certified Behavior Analyst
Teach Me Personnel LLC - Therapy & Beyond is one of the largest BCBA-owned ABA organizations, founded and led by Dr
🇺🇸Added 3h ago
Senior Board Certified Behavior Analyst
Teach Me Personnel LLC - Therapy & Beyond is one of the largest BCBA-owned ABA organizations, founded and led by Dr
🇺🇸Added 3h ago
Senior Board Certified Behavior Analyst
Teach Me Personnel LLC - Therapy & Beyond is one of the largest BCBA-owned ABA organizations, founded and led by Dr
🇺🇸Added 3h ago
Senior Board Certified Behavior Analyst
Teach Me Personnel LLC - Therapy & Beyond is one of the largest BCBA-owned ABA organizations, founded and led by Dr
🇺🇸Added 5h ago
Mechanical Engineer
Olsson Associates - A team-based, purpose-driven engineering and design firm.(Civil Engineering)
Remote🇺🇸Added 5h ago
Senior Mechanical Engineer
Olsson Associates - A team-based, purpose-driven engineering and design firm.(Civil Engineering)