Job Description
Highmark Health
Value-Based Reimbursement Specialist
Highmark Health • Pennsylvania, United States • via Highmark Health Careers
2 days ago
Full–time
Apply directly on Highmark Health Careers
Apply on Workday
Apply on Teal
Apply on Remote Jobs In USA
Apply on Glassdoor
Apply on Remoteway
Apply on Workvista
Qualifications
5 years of Work experience in the primary care and the ambulatory care environment, healthcare insurance industry, healthcare administration in primary care, or healthcare consulting in primary care or population health management
3 years of experience in data analysis, interpretation, and outcomes strategic plan development
1 year experience with Medicare STARS, Medicaid HEDIS, risk revenue value streams, and population health management
11 more items(s)
Benefits
$67,500.00
$126,000.00
The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets
Responsibilities
This job is responsible for key strategic initiatives for the Markets and Provider Transformation Organization supporting the matrixed teams that engage providers enrolled in the Organization’s value-based reimbursement programs and continuous improvement models
The incumbent plays different potential roles on a given project, to include elements of project leadership, problem-solving, data analytics, team development, communication, implementation, and project management
The incumbent often plays a central role in the development and execution of the strategy for a given initiative for transformation of workflows resulting in outstanding performance in the Organization’s value-based reimbursement programs ensuring that ROI targets as set by the Organization are met or exceeded
30 more items(s)
More job highlights
Job description
Company :
Highmark Inc.Job Description :
JOB SUMMARY
This job is responsible for key strategic initiatives for the Markets and Provider Transformation Organization supporting the matrixed teams that engage providers enrolled in the Organization’s value-based reimbursement programs and continuous improvement models. The incumbent plays different potential roles on a given project, to include elements of project leadership, problem-solving, data analytics, team development, communication, implementation, and project management. The incumbent often plays a central role in the development and execution of the strategy for a given initiative for transformation of workflows resulting in outstanding performance in the Organization’s value-based reimbursement programs ensuring that ROI targets as set by the Organization are met or exceeded. The position collaborates with various teams within data analytics and infrastructure to support the creation, optimization, and maintenance of self-service resources for providers, entities, and health systems within these programs. Works on multiple projects and has exposure to all parts of the Organization, and will play a supportive role in planning, communicating, and managing the market strategy.
ESSENTIAL RESPONSIBILITIES
• Participate in the development of strategic plans for the Enterprise and Markets and Provider Transformation and the key BU's for the Organization’s value-based reimbursement programs and continuous improvement models. Lead or support key strategic initiatives across Enterprise and Markets and Provider Transformation for the Organization’s value-based reimbursement programs and continuous improvement models. Role will vary depending on initiative, but will include elements of team leadership, problem-solving, data analysis, project management, communication, implementation, and provider and/or provider-facing team education support. Will participate on a portfolio of projects.
• Serve as a subject matter expert working in concert with provider-facing teams to explain new programs and results to key provider partners as needed. Collaborate on product development and the creation, optimization, and maintenance of a self-service platform for providers, entities, and health systems within the Organization’s value-based reimbursement programs for both the commercial and government business with a focus on enterprise goals including but not limited to Government Markets (STARS, ACA, CHIP, Medicaid DE) and Enterprise Quality, Safety, and Values (Health Outcomes Measures). Provide actionable opportunities in provider transformation aimed at high-quality, cost-effective care while improving patient outcomes.
• Provide consultative workflow transformation and training/education services to matrixed teams supporting providers enrolled in the organization's value-based reimbursement programs. Strong knowledge of risk adjustment methodologies and reporting/regulatory requirements and CMS Stars rating measures including HEDIS, CAHPS, Pharmacy, HOS, PQA, PQRS.
• Support development of the overall conceptualization, strategy alignment, and high-level design of new value-based reimbursement models for PCPs, specialists, and health systems across the Organization's footprint, based on deep understanding and knowledge of trends in other areas of the country with both government and private payers. Programs will include but not be limited to pay-for-value programs, episode payments, prospective bundled payments, gain share and risk share models and will be implemented for the Organization's Medicare Advantage, Medicaid, ACA, and commercial populations with the goal of maximizing quality while reducing healthcare costs.
• Support the identification of initiative impacts with other strategic initiatives to ensure alignment of the overall strategy to support the quintuple aim.
• Provide feedback and collaborate with the analytics team to ensure data points are accurate and provide meaningful, actionable data. Provide support to matrixed teams in the use of predictive analytic tools, user interfaces, population health management tools and other data-based platforms endorsed by the Organization.
• Support the team in identifying, clarifying, and resolving complex issues critical to the success of the initiative and play a role in shaping the culture and skill set of the Markets and Provider Transformation Organization.
• Other duties as assigned or requested.
EXPERIENCE
Required
• 5 years of Work experience in the primary care and the ambulatory care environment, healthcare insurance industry, healthcare administration in primary care, or healthcare consulting in primary care or population health management.
• 3 years of experience in data analysis, interpretation, and outcomes strategic plan development.
• 1 year experience with Medicare STARS, Medicaid HEDIS, risk revenue value streams, and population health management.
Preferred
• 7 years of experience in managed care, primary care management or other clinical setting.
• Experience in Lean, Six Sigma, TQI, TQC or other quality management certification.
• Experience in health plan provider network performance management, population health management, continuous improvement, or provider engagement models
• Experience influencing change in complex organizational systems.
SKILLS
• Must be able to effectively resolve issues and problems across all areas of the corporation, by understanding corporate strategies, policy, and scope of authority
• Because of the broad impact of decisions that are made, must be knowledgeable and sensitive to many internal and external corporate issues
• Aptitude for a high visibility position demanding integrity, uncompromising professionalism, diplomacy and conflict management
• Basic project management skills
• Proactive in driving change and continuous improvement
• Demonstrated influencing and teamwork skills
• Strong quantitative, analytical, and time management skills
• Demonstrates a deep understanding of primary care practice operations and workflow across the continuum of variability in primary care and experience in managing provider and administrative leadership relationships
• Superior written and verbal communication skills and listening skills
• Ability to adapt engagement strategies to meet market needs
EDUCATION
Required
• Bachelors in Clinical or healthcare industry discipline OR relevant experience and/or education as determined by the company in lieu of bachelor's degree
Preferred
• Masters
LICENSES or CERTIFICATIONS
Required
• None
Preferred
• None
Language (Other than English):
None
Travel Requirement:
Less than 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office- or Remote-based
Teaches / trains others
Occasionally
Travel 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
Occasionally
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 1++6 (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.
Pay Range Minimum:
$67,500.00
Pay Range Maximum:
$126,000.00
Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
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 any category protected by applicable federal, state, or local law.
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 the email below.
For accommodation requests, please contact HR Services Online at [email protected]
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Report this listing
Highmark Health
Glassdoor
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Care.com
[Hiring] Child Caregiver @Care.com
Care.com • via Remotive
1 day ago
Part-time
No Degree Mentioned
Apply on Remotive
Apply on Indeed Jobs
Job description
About Care.com:
Care.com is a consumer tech company with heart. We’re on a mission to solve a human challenge we all face: finding great care for the ones we love. We’re moms and dads and pet parents. We have parents and grandparents so we understand that everyone, at some point in their lives, could use a helping hand. Our culture and our products reflect that.
What is Care for Business?
Care for Business, by Care.com, is the fastest-growing provider of Backup Child Care. We work with the world's most innovative companies to help their employees when their regular child care coverage falls through. We connect families and our amazing caregivers with meaningful job opportunities every day. We do the hard work of ensuring you are booked with families that are a match when it comes to your designated travel areas, childcare experience, and availability. All you need to focus on is providing wonderful and engaging childcare!
Benefits of Working with Care for Business:
• Weekly pay with competitive monthly bonusing based directly on your individual contributions
• A full-service team to support your part-time schedule. We bring the work to you!
• Accrued Sick time and Vacation time
• Flexible schedule
• Mileage Reimbursement (over 40 mi)
What Your Days Will be Like:
As a Caregiver within our Care for Business team, you will have the opportunity to care for children of multiple families in your area! You will be responsible for creating a safe, nurturing, and stimulating environment for the children under your care. Our team will automatically place you in jobs based on your experience, location, and availability!
• Conduct Intro Calls with each family you're booked with
• Care for children in their homes, typically an 8-hour day
• Abide by and follow the schedule and rules set forth by parents
• Perform household duties relating to the care you provide; i.e. cleaning up after meals, doing dishes, and cleaning up after activities
What You’ll Need to Succeed:
• Must be 18 years or older
• Minimum of 1 weekday availability to work (at least 8 consecutive hours between 6am-8pm)
• Related childcare experience
• Reliable transportation to reach families’ homes and ability to travel up to 15 miles from your home
• Adult, Infant, and Pediatric CPR/First Aid Required prior to start date (will provide reimbursement for certification)
• Familiarity and ability to use app-based products and electronic devices
• Authorized to work in the United States
Physical Requirements:
• Prolonged periods of standing and frequent bending
• Must be able to lift up to 50 lbs at one time
• Exposure to mildly sick children
Compensation Range: $1+ to $21 hourly. The base compensation range above represents the anticipated low and high end of the national salary range for this position. Actual compensation may vary and may be above or below the range based on various factors including but not limited to work location, experience, and performance. The range listed is just one component of Care.com’s total compensation package for employees. Other rewards may include annual bonuses and short- and long-term incentives. In addition, Care.com provides a variety of benefits to employees, including health insurance coverage, life, and disability insurance, a generous 401K employer matching program, paid holidays, and paid time off (PTO).
• Care.com supports diverse families and communities and seeks employees who are just as diverse. As an equal opportunity employer, Care.com recognizes the power of a diverse and inclusive workforce and encourages applications from individuals with varied experiences, perspectives, and backgrounds. Care.com is committed to providing reasonable accommodations for qualified individuals with disabilities. If you need assistance or an accommodation, please reach out to [email protected].
__________________________________________________________________________________________________________________________
Company Overview:
Available in more than 20 countries, Care.com is the world's leading platform for finding and managing high-quality family care. Care.com is designed to meet the evolving needs of today's families and caregivers, offering everything from household tax and payroll services and customized corporate benefits packages covering the care needs of working families, to innovating new ways for caregivers to be paid and obtain professional benefits. Since 2007, families have relied on Care.com's industry-leading products—from child and elder care to pet care and home care. Care.com is an IAC company (NASDAQ: IAC).
Value-Based Reimbursement Specialist
Highmark Health • Pennsylvania, United States • via Highmark Health Careers
2 days ago
Full–time
Apply directly on Highmark Health Careers
Apply on Workday
Apply on Teal
Apply on Remote Jobs In USA
Apply on Glassdoor
Apply on Remoteway
Apply on Workvista
Qualifications
5 years of Work experience in the primary care and the ambulatory care environment, healthcare insurance industry, healthcare administration in primary care, or healthcare consulting in primary care or population health management
3 years of experience in data analysis, interpretation, and outcomes strategic plan development
1 year experience with Medicare STARS, Medicaid HEDIS, risk revenue value streams, and population health management
11 more items(s)
Benefits
$67,500.00
$126,000.00
The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets
Responsibilities
This job is responsible for key strategic initiatives for the Markets and Provider Transformation Organization supporting the matrixed teams that engage providers enrolled in the Organization’s value-based reimbursement programs and continuous improvement models
The incumbent plays different potential roles on a given project, to include elements of project leadership, problem-solving, data analytics, team development, communication, implementation, and project management
The incumbent often plays a central role in the development and execution of the strategy for a given initiative for transformation of workflows resulting in outstanding performance in the Organization’s value-based reimbursement programs ensuring that ROI targets as set by the Organization are met or exceeded
30 more items(s)
More job highlights
Job description
Company :
Highmark Inc.Job Description :
JOB SUMMARY
This job is responsible for key strategic initiatives for the Markets and Provider Transformation Organization supporting the matrixed teams that engage providers enrolled in the Organization’s value-based reimbursement programs and continuous improvement models. The incumbent plays different potential roles on a given project, to include elements of project leadership, problem-solving, data analytics, team development, communication, implementation, and project management. The incumbent often plays a central role in the development and execution of the strategy for a given initiative for transformation of workflows resulting in outstanding performance in the Organization’s value-based reimbursement programs ensuring that ROI targets as set by the Organization are met or exceeded. The position collaborates with various teams within data analytics and infrastructure to support the creation, optimization, and maintenance of self-service resources for providers, entities, and health systems within these programs. Works on multiple projects and has exposure to all parts of the Organization, and will play a supportive role in planning, communicating, and managing the market strategy.
ESSENTIAL RESPONSIBILITIES
• Participate in the development of strategic plans for the Enterprise and Markets and Provider Transformation and the key BU's for the Organization’s value-based reimbursement programs and continuous improvement models. Lead or support key strategic initiatives across Enterprise and Markets and Provider Transformation for the Organization’s value-based reimbursement programs and continuous improvement models. Role will vary depending on initiative, but will include elements of team leadership, problem-solving, data analysis, project management, communication, implementation, and provider and/or provider-facing team education support. Will participate on a portfolio of projects.
• Serve as a subject matter expert working in concert with provider-facing teams to explain new programs and results to key provider partners as needed. Collaborate on product development and the creation, optimization, and maintenance of a self-service platform for providers, entities, and health systems within the Organization’s value-based reimbursement programs for both the commercial and government business with a focus on enterprise goals including but not limited to Government Markets (STARS, ACA, CHIP, Medicaid DE) and Enterprise Quality, Safety, and Values (Health Outcomes Measures). Provide actionable opportunities in provider transformation aimed at high-quality, cost-effective care while improving patient outcomes.
• Provide consultative workflow transformation and training/education services to matrixed teams supporting providers enrolled in the organization's value-based reimbursement programs. Strong knowledge of risk adjustment methodologies and reporting/regulatory requirements and CMS Stars rating measures including HEDIS, CAHPS, Pharmacy, HOS, PQA, PQRS.
• Support development of the overall conceptualization, strategy alignment, and high-level design of new value-based reimbursement models for PCPs, specialists, and health systems across the Organization's footprint, based on deep understanding and knowledge of trends in other areas of the country with both government and private payers. Programs will include but not be limited to pay-for-value programs, episode payments, prospective bundled payments, gain share and risk share models and will be implemented for the Organization's Medicare Advantage, Medicaid, ACA, and commercial populations with the goal of maximizing quality while reducing healthcare costs.
• Support the identification of initiative impacts with other strategic initiatives to ensure alignment of the overall strategy to support the quintuple aim.
• Provide feedback and collaborate with the analytics team to ensure data points are accurate and provide meaningful, actionable data. Provide support to matrixed teams in the use of predictive analytic tools, user interfaces, population health management tools and other data-based platforms endorsed by the Organization.
• Support the team in identifying, clarifying, and resolving complex issues critical to the success of the initiative and play a role in shaping the culture and skill set of the Markets and Provider Transformation Organization.
• Other duties as assigned or requested.
EXPERIENCE
Required
• 5 years of Work experience in the primary care and the ambulatory care environment, healthcare insurance industry, healthcare administration in primary care, or healthcare consulting in primary care or population health management.
• 3 years of experience in data analysis, interpretation, and outcomes strategic plan development.
• 1 year experience with Medicare STARS, Medicaid HEDIS, risk revenue value streams, and population health management.
Preferred
• 7 years of experience in managed care, primary care management or other clinical setting.
• Experience in Lean, Six Sigma, TQI, TQC or other quality management certification.
• Experience in health plan provider network performance management, population health management, continuous improvement, or provider engagement models
• Experience influencing change in complex organizational systems.
SKILLS
• Must be able to effectively resolve issues and problems across all areas of the corporation, by understanding corporate strategies, policy, and scope of authority
• Because of the broad impact of decisions that are made, must be knowledgeable and sensitive to many internal and external corporate issues
• Aptitude for a high visibility position demanding integrity, uncompromising professionalism, diplomacy and conflict management
• Basic project management skills
• Proactive in driving change and continuous improvement
• Demonstrated influencing and teamwork skills
• Strong quantitative, analytical, and time management skills
• Demonstrates a deep understanding of primary care practice operations and workflow across the continuum of variability in primary care and experience in managing provider and administrative leadership relationships
• Superior written and verbal communication skills and listening skills
• Ability to adapt engagement strategies to meet market needs
EDUCATION
Required
• Bachelors in Clinical or healthcare industry discipline OR relevant experience and/or education as determined by the company in lieu of bachelor's degree
Preferred
• Masters
LICENSES or CERTIFICATIONS
Required
• None
Preferred
• None
Language (Other than English):
None
Travel Requirement:
Less than 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office- or Remote-based
Teaches / trains others
Occasionally
Travel 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
Occasionally
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 1++6 (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.
Pay Range Minimum:
$67,500.00
Pay Range Maximum:
$126,000.00
Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
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 any category protected by applicable federal, state, or local law.
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 the email below.
For accommodation requests, please contact HR Services Online at [email protected]
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Report this listing
Highmark Health
Glassdoor
3.3/5
1.4K reviews
Indeed
3.1/5
1K reviews
Comparably
3/5
125 reviews
highmark.com
More jobs at Highmark Health
See web results for Highmark Health
Care.com
[Hiring] Child Caregiver @Care.com
Care.com • via Remotive
1 day ago
Part-time
No Degree Mentioned
Apply on Remotive
Apply on Indeed Jobs
Job description
About Care.com:
Care.com is a consumer tech company with heart. We’re on a mission to solve a human challenge we all face: finding great care for the ones we love. We’re moms and dads and pet parents. We have parents and grandparents so we understand that everyone, at some point in their lives, could use a helping hand. Our culture and our products reflect that.
What is Care for Business?
Care for Business, by Care.com, is the fastest-growing provider of Backup Child Care. We work with the world's most innovative companies to help their employees when their regular child care coverage falls through. We connect families and our amazing caregivers with meaningful job opportunities every day. We do the hard work of ensuring you are booked with families that are a match when it comes to your designated travel areas, childcare experience, and availability. All you need to focus on is providing wonderful and engaging childcare!
Benefits of Working with Care for Business:
• Weekly pay with competitive monthly bonusing based directly on your individual contributions
• A full-service team to support your part-time schedule. We bring the work to you!
• Accrued Sick time and Vacation time
• Flexible schedule
• Mileage Reimbursement (over 40 mi)
What Your Days Will be Like:
As a Caregiver within our Care for Business team, you will have the opportunity to care for children of multiple families in your area! You will be responsible for creating a safe, nurturing, and stimulating environment for the children under your care. Our team will automatically place you in jobs based on your experience, location, and availability!
• Conduct Intro Calls with each family you're booked with
• Care for children in their homes, typically an 8-hour day
• Abide by and follow the schedule and rules set forth by parents
• Perform household duties relating to the care you provide; i.e. cleaning up after meals, doing dishes, and cleaning up after activities
What You’ll Need to Succeed:
• Must be 18 years or older
• Minimum of 1 weekday availability to work (at least 8 consecutive hours between 6am-8pm)
• Related childcare experience
• Reliable transportation to reach families’ homes and ability to travel up to 15 miles from your home
• Adult, Infant, and Pediatric CPR/First Aid Required prior to start date (will provide reimbursement for certification)
• Familiarity and ability to use app-based products and electronic devices
• Authorized to work in the United States
Physical Requirements:
• Prolonged periods of standing and frequent bending
• Must be able to lift up to 50 lbs at one time
• Exposure to mildly sick children
Compensation Range: $1+ to $21 hourly. The base compensation range above represents the anticipated low and high end of the national salary range for this position. Actual compensation may vary and may be above or below the range based on various factors including but not limited to work location, experience, and performance. The range listed is just one component of Care.com’s total compensation package for employees. Other rewards may include annual bonuses and short- and long-term incentives. In addition, Care.com provides a variety of benefits to employees, including health insurance coverage, life, and disability insurance, a generous 401K employer matching program, paid holidays, and paid time off (PTO).
• Care.com supports diverse families and communities and seeks employees who are just as diverse. As an equal opportunity employer, Care.com recognizes the power of a diverse and inclusive workforce and encourages applications from individuals with varied experiences, perspectives, and backgrounds. Care.com is committed to providing reasonable accommodations for qualified individuals with disabilities. If you need assistance or an accommodation, please reach out to [email protected].
__________________________________________________________________________________________________________________________
Company Overview:
Available in more than 20 countries, Care.com is the world's leading platform for finding and managing high-quality family care. Care.com is designed to meet the evolving needs of today's families and caregivers, offering everything from household tax and payroll services and customized corporate benefits packages covering the care needs of working families, to innovating new ways for caregivers to be paid and obtain professional benefits. Since 2007, families have relied on Care.com's industry-leading products—from child and elder care to pet care and home care. Care.com is an IAC company (NASDAQ: IAC).
💡 Quick Summary
Seeking a career-building opportunity? The [Hiring] Child Caregiver @Care.com position is now open for candidates interested in the Work from home Jobs sector. This role in Abee offers a professional environment and growth potential.
Requirement Snapshot: Candidates should possess basic communication skills, a proactive attitude, and the ability to work in a team. Experience in Work from home Jobs is a plus.
