Manager Provider Government Programs

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Manager Provider Government Programs

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Manager Provider Government Programs

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PA, Working at Home - Pennsylvania

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This job is responsible for the performance and development of the clinical consultants into highly functioning subject matter experts in the Organization"s Primary Care Provider government programs and continuous improvement models in a matrix management environment . This includes responsibility for value creation, impact and cost control, inter-departmental outcomes/goals based upon Highmark's fiscal ROI target results in the program(s), such as improvements in quality, cost and utilization through care gap closure, STARS ratings and risk revenue performance as defined by the government program.

This role can be hybrid or remote. If you live within 50 miles of an office you are required to be onsite 3 days a week. T, W, Th.

ESSENTIAL RESPONSIBILITIES

• Performs management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.
• Plans, organizes, staffs, directs and controls the day-to-day operations of the department; develops and implements policies and programs as necessary; may have budgetary responsibility and authority.
• Responsible for value creation, impact and cost control through the departmental day to day operations and clinical consultant performance in meeting or exceeding the ROI and fiscal targets as set by Highmark, cost and utilization and quality results in Medicare STARS, Medicaid HEDIS and risk revenue government programs. This includes accountability for team development to provide subject matter experts to the Organization Entity, provider network, innovations and partnership department, provider relations, and Highmark's strategic PCP partners in government programs in Medicare, Medicaid HEDIS and risk revenue, and user interfaces endorsed by the Organization.
• Participates in the research, development and implementation of innovative strategic plans based upon analysis and interpretation of the outcomes and financial data to align with Highmark's entity wide fiscal/ROI and performance goals. This requires superior commination skills in developing, maintaining and managing collaborative relationships and reporting structures with key internal and external stake holders and includes driving the continuous improvement process activities to enhance departmental performance and reduce administrative costs.
• Responsible for collaboration with operations team for government program management and meeting ROI/fiscal goals set by the Organization. This includes remaining current in market trends, government cost and quality programs, and innovative research in primary care models of care delivery. Through strategic assessment and execution, responsible to assess market needs/gaps, on an on-going basis, based upon financial/ROI outcomes, and develop/implement mitigation plans to meet needs/gaps.
• Responsible for building and sustaining relationships with the Organization provider network(s), regulators, professional/clinical societies and other organizations endorsed by the Organization for success of government program outcomes.
• Other duties as assigned or requested.
• Other duties as assigned or requested.

REQUIRED EDUCATION

Bachelor"s Degree- Clinical specialty or healthcare related field

Substitutions

No Substitutions

PREFERRED EDUCATION

Master"s Degree - Business or Healthcare Administration discipline.

EXPERIENCE

Minimum:

• 5 years' experience in any combination of healthcare, government quality improvement programs, Medicare/Medicaid and risk revenue, medical staff management, healthcare consulting in government business, primary care administration, including revenue cycle management, or related area.
• 3 years" experience in government program quality improvement, data analysis, and strategic plan development based upon data.
• 3 years" of progressive management experience.

Preferred:

• Matrix management, strategic planning and execution experience
• Lean Six Sigma, TQI, CQI, other total quality, process engineering training/certification is a plus
• Project Management certification is a plus
• Clinical Licensure is highly desirable, and ability to manage/lead highly trained clinical professional level employees is essential
• Certified Professional in Healthcare Quality, American College of Healthcare Executives certification, preferred

KNOWLEDGE, SKILLS & ABILITIES

• 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, the incumbent must be knowledgeable and sensitive to many internal and external corporate issues
• Aptitude for a high visibility position demanding integrity, uncompromising professionalism, diplomacy, conflict management, experience in managing provider and administrative leadership relationships, political awareness, superior written and verbal communication skills, superior listening skills, excellence in strategic planning, and ability to flex staff and departmental direction in response to outcomes dashboards for superior results
• Deep, operational interpretation/understanding of outcomes data and financial reports
• Superior communication and interpersonal relationship skill with both internal and external stake-holders
• Experienced in data analysis and interpretation, performance in outcomes based staff management, Medicare STARS, Medicaid HEDIS and risk revenue
• Highly skilled strategic thinker and executer in the development and deployment of a high performing staff

REQUIRED LICENSURE

None

PREFERRED LICENSURE

None

TRAVEL REQUIREMENT: 50% - 75%

LANGUAGE REQUIREMENT (other than English)?

PHYSICAL, MENTAL DEMANDS AND WORKING CONDITIONS

Position Type:

Office-Based or Remote

Office-Based Positions

An employee in this position works in an office environment. The position frequently requires the employee to communicate effectively with others both inside and outside the workplace (e.g., in person, via telephone, via email). The employee must be able to understand, interpret and analyze data, solve problems, concentrate, and research, use available technological resources and systems (e.g., computers and computer programs), multi-task, prioritize, and meet multiple deadlines to complete essential tasks. The employee generally works in a fast-paced and frequently stressful environment, must attend work on a regular and reliable basis as well as adhere to all workplace policies, and may be called upon to work outside regular business hours.

Teaches/Trains others regularly

Frequently

Travels 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) Does Not Apply

Physical Work Site Required No

Lifting: up to 10 pounds

Occasionally

Lifting: 10 to 25 pounds

Never

Lifting: 25 to 50 pounds

Never

ADDITIONAL INFORMATION

Changes Approved By:

Melanie Lysne

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

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.

Pay Range Minimum:

$94,200.00

Pay Range Maximum:

$151,000.00

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 HRServices@highmarkhealth.org

California Consumer Privacy Act Employees, Contractors, and Applicants Notice

Recruitment Fraud Alert

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Job Details

• Job category Provider Services
• Position Type Full Time
• Posted 07/16/2026
• Location(s) PA, Working at Home - Pennsylvania
• Line of Business
• Entity
• Recruiter
• Hiring Manager
• Experience Level
• Job Family Provider Relations-HM
• Req ID J284608

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Highmark Health is an independent licensee of the Blue Cross Blue Shield Association.

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 HRServices@highmarkhealth.org.

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