VP, Health Engagement - Medicaid

Highmark Inc. Health Engagement Team Leader

This job is responsible for leading, optimizing, and transforming all operational aspects of member facing health engagement team activities through case management, disease management, and programs targeted at behavioral health, pharmacy, wellness and social work delivered in the context of a digitally enabled whole-person health model that seeks to establish contextualization and personalization of a dynamic care plan, while enabling efficient access to any combination of co-morbid condition management solutions with seamless omni-channel handoffs. As a key leader of the Medicaid Clinical organization, role is responsible for maximizing and optimizing value of the programs through delivery and as such, is accountable for customer activation, engagement, and experience, quality delivery, health outcomes, care cost management, and operational excellence / administrative cost management. This requires the incumbent to lead their team through the implementation of alternative resourcing strategies and digital transformation of the function. The role is accountable for growing measurable financial and clinical value, both internally within Highmark's membership population as well as with external provider partners. This will require close partnership with leaders across the enterprise and direct interactions with senior leaders at clients and providers. This job requires a strategic approach to team development, talent management, and performance optimization, ensuring seamless integration with other departments and a positive impact on member outcomes.

Essential Responsibilities

• Lead and manage a large, multi-disciplinary team : Responsible for delivering and executing member-facing clinical programs which include, fostering a collaborative environment, developing talent, and ensuring the team is equipped to manage case management, transitions of care, and disease management programs. Additionally, this role encompasses managing reporting relationships, hiring and termination decisions, coaching and development, performance management, and staff productivity. It also involves planning, organizing, and directing the day-to-day operations of the department, developing policies and programs, and managing budgets.
• Ensure operational excellence : Oversee performance review processes, monitor key performance indicators, and deliver expected outcomes in areas like activation, engagement, quality, health, and cost.
• Maintain compliance : Implement and oversee a comprehensive compliance program for clinical services, ensuring adherence to NCQA standards and all applicable regulations.
• Drive continuous improvement : Continuously deploy agile best practices, enhance operations based on market intelligence, and connect Population Health clinical programs to support a whole-person health model.
• Providing comprehensive member support : This includes guiding members through the healthcare system, helping them choose and use their insurance, connecting them with the right tools and resources, increasing engagement in clinical programs, creating targeted campaigns, scheduling appointments, and facilitating medical record transfers.
• Drive strategic alignment and growth : Partner with Product Management teams to enhance enterprise value through improved clinical outcomes, affordability, and growth. This includes providing business expertise, sharing customer insights, and ensuring alignment with business objectives.
• Operationalize change and innovation : Lead change management activities related to technical and digital transformation efforts. Deploy engagement best practices, innovate member engagement strategies, and leverage design expertise to optimize customer and clinician experiences.
• Collaborate for seamless integration : Partner with Customer Experience teams to ensure that the roadmap and design of the customer experience amplifies activation and engagement, and integrates seamlessly with clinical program operations. This includes developing a multi-year roadmap for digital transformation of clinical operations and member engagement capabilities.
• Collaborate across the organization to develop and implement value-driven clinical programs and solutions : This includes partnering with various teams, including the Government Business Segment, enGen, and strategic anchor providers, to create, sell, and deliver products and services that drive incremental enterprise value, improve clinical outcomes, and align with the quintuple aim.
• Drive strategic initiatives and communication : Lead multiple simultaneous work streams and projects, engage in speaking engagements, and communicate strategic ideas effectively through writing, presentations, and storytelling.

Education

Experience

Preferred Experience

Licenses or Certifications

Required : None

Preferred : None

Language (Other than English) :

None

Travel Requirement : 0% - 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 No

Lifting : up to 10 pounds Constantly

Lifting : 10 to 25 pounds Occasionally

Lifting : 25 to 50 pounds Rarely