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Highmark Health Director Business Platform - Healthcare Provider Domain (Remote) in Home, Massachusetts

Company :

Highmark Health

Job Description :

GENERAL OVERVIEW:

Direct the strategic business and functional infrastructure (existing and future) of the healthcare provider systems that support the business platforms for all health insurance products, programs, ancillary services and markets served by Highmark. Acts as business owner of these functions and directs the daily operations of the underlying systems, defines strategic and tactical initiatives to improve these business platforms, defines and supports the underlying workflow of these systems, and is a major contributor to the corporate and/or divisional strategic planning process and executive management team. In addition to defining and supporting the underlying systems and processes, the incumbent is responsible for directing the identification of enhancements and expanded capabilities of these major enterprise systems this responsibility includes design, developing, modifying, adapting and implementing short- and long-term solutions to information technology (IT) and business process solutions through new and existing applications, systems architecture, network systems and applications infrastructure. Reviews system requirements and business processes, participates in code walkthroughs and tests, debugs to implement software solutions.

ESSENTIAL RESPONSIBILITIES:

  1. Acts as business owner of these functions and directs the daily operations of the underlying systems, defines strategic and tactical initiatives to improve these operations and systems, defines and supports the underlying workflow of these systems. Responsible for directing the identification of enhancements and expanded capabilities of these major enterprise systems through direct facilitation with the user community.

  2. Serves as the virtual Program Manager for the underlying systems and processes and directs the infrastructure support for the respective business platform and directs platform support and integration of data and knowledge used to service group customers, consumer’s and/or providers.

  3. Resolve high impact platform problems and consequences. Adheres to corporate and BCBSA performance measurements and standards as well as compliance to Federal and state mandates. Directly facilitates active and ongoing communication with the user community.

  4. Responsible for driving the design, development, modification, adaptation and implementation of short- and long-term solutions to information technology (IT) and business process solutions through new and existing applications, systems architecture, network systems and applications infrastructure

  5. Identify, implement, and adhere to multi-state and federal government regulations, corporate policy mandates, corrective action plans, compliance requirements and process improvement initiatives impacting systems, operating platform and associated process and workflows.

  6. Work with executive leaders to develop the department and corporate strategic and tactical plans. Directly responsible for their departments annual planning process and documentation of their plan. Responsible for facilitation of all necessary planning to support the annual corporate strategic planning process as it relates to their assigned applications and impacts to those systems or processes.

  7. This role will at times also be accountable to directly deliver projects or programs and/or actively participate in transformational initiatives. These could include managing complex matrix relationships across business units or even business entities within Highmark or its strategic business partners. When this is the case, there may be less direct reporting relationships and more matrix relationships demanding extensive relationship management skills. These types of assignments would be of the small to medium sized projects / programs and/or mid-level complexity or scope.

  8. Other duties as assigned or requested.

III. QUALIFICATIONS:

Minimum

  • High School Diploma or GED

  • 7 years program management or direct management experience

  • 5 year’s experience managing technology related projects and experience working with operational computer systems.

  • 5 years’ experience utilizing various industry laws and regulations.

Preferred

  • Bachelor’s Degree

  • 5 years extensive insurance product knowledge

  • 5 years’ experience in workforce development and resource management.

  • 5 year’s experience in business process improvement

  • Ideal candidate will have 5+ years of leadership experience in Healthcare provider business OR Hospital management

  • Program / Project Management professional designation (PMP / PgMP)

Knowledge, Skills and Abilities

  • Leadership skills and ability to relate to all levels of management and staff as well as external customers.

  • Experience evaluating technology for implementation in gaining improved services

  • Experience in reengineering processes and procedures to achieve costs reductions

  • Strong business writing and oral communication skills.

  • Excellent team building and professional development skills.

  • Advanced negotiation and influencing skills.

IV. SCOPE OF RESPONSIBILITY

Does this role supervise/manage other employees? Yes

V. WORK ENVIRONMENT

Is Travel Required? Yes

Unusual Working Conditions

  • Standard. Fast-paced with multiple, competing priorities.

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, 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, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

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_files/employers/poster_screen_reader_optimized.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

Req ID: J197311

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