Clinical Transformation Physician Executive at Highmark Health

Company

Highmark Health Job Description

JOB SUMMARY

This job will serve as the clinical dyad to the provider partnerships market leader. This incumbent is accountable for the clinical aspect of opportunity identification, design, readiness, and adoption of the living health solutions and programs to reinvent health. The Incumbent will manage clinical capability assessments and interaction with provider systems to determine feasibility and consistency of adopting best practice approaches to achieve the best health outcomes. Will identify new opportunities based on clinical insights, define meaningful interventions and lead communication and change management support. The incumbent will partner with the provider leaders to ensure expert clinical resources and other provider partner resources needed for an effective implementation and transformation process are deployed.

ESSENTIAL RESPONSIBILITIES

• Serve as the clinical dyad to the living health partnership market leader and co-lead the coordination of solution opportunity, design, readiness, and adoption at provider partners.

• Represent the clinical point of view on

• All decisions related to the identification, build-out and management of solutions at provider partners.

• Opportunities to incorporate solutions from provider partners into Living Health.

• Serve as an ambassador for Highmark Health and its strategy to provider partners in the context of this role.

• Assist in the development of the implementation framework, playbook, and approach for bringing innovative clinical solutions to provider partners.

• Work with clinicians and administrators to identify key variability challenges and engage appropriate clinical expertise across multiple provider systems for validation and involvement in the process of solution design.

• Partner with the living health partnership market leader on program and clinical process adoption, activation of onsite work streams, and engagement of administration across provider partners.

• Develop and enhance clinical leadership relationships with community hospitals, independent physicians and clinically integrated networks (CINs) in the region, to expand and solidify the presence of Highmark Health.

• Provide other clinical duties as assigned within the enterprise.

EDUCATION

Required

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO)

Substitutions

• None

Preferred

• None

EXPERIENCE

Required

• Practicing physician with at least 10+ years clinical practice

• Board Certified physician with a current, unrestricted medical license in any US State

• Demonstrated record of clinical leadership, including experience leading multi-disciplinary clinical teams and multi-specialty physician groups

• Experience working in a highly matrixed clinical structure

Preferred

• None

LICENSES or CERTIFICATIONS

Required

• Current MD or DO; Must hold a current board certification in field of study

Preferred

• None

SKILLS

• Successfully partners through collaboration and sense of urgency regarding process implementation and improvement/optimization.

• Experience in matrix management, including own function and providing matrix oversight to others

• Ability to critically appraise and apply the latest medical evidence to inform clinical pathways and care models

• Strong analytical skills to identify complex clinical and operational challenges and develop innovative solutions

• Experience with Value Based Care programs and the needed population health infrastructure, quality processes and care management support to be sucessful

• Ability to understand and interpret complex healthcare data (e.g., claims data, EHR data, quality metrics) to identify trends, opportunities, and areas for improvement. Utilization of data to inform clinical strategy, measure outcomes, and demonstrate value.

• Understanding the financial drivers of healthcare, including reimbursement models, cost-effectiveness, and resource allocation. Capacity to evaluate the financial impact of clinical transformation initiatives to inform financial modeling

• Highly motivated with exceptional organizational skills, including the ability to effectively and competently handle multiple responsibilities simultaneously and the flexibility and ability to quickly adapt to changes in work objectives, promotions, and available technology

• Demonstrated success in building organizational consensus and leading by influence

• Strong oral and written communication skills, can visually convey concepts

• Ability to present complex concepts clearly and concisely to a wide range of audiences

• Exhibits problem solving skills and productively manages conflict

Language (Other than English)

None

Travel Requirement

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Most On-the-Road

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site Frequently

Frequently

Physical work site required

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occastionally

Lifting: 25 to 50 pounds

Never

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 any category protected by applicable federal, state, or local law.

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