Director of Reimbursement Strategy and Market ...

Company: Highmark Inc. Job Description: JOB SUMMARY This position plays a crucial role in enhancing reimbursement strategies through a collaborative approach. The successful candidate will engage with stakeholders throughout the organization to create and implement a comprehensive plan for introducing innovative reimbursement models across all markets and product lines. This includes aligning models with the health plan's strategic goals and keeping abreast of industry innovations in both commercial and government sectors. The team will focus on developing and maintaining models that optimize return on investment (ROI) and inform decision-making on payer partnerships. Essential functions also involve identifying new operational capabilities required to support these models and aligning them with Highmark's strategic roadmap. Collaboration with Advanced Analytics, Contracting, Market and Provider support teams, and other internal partners is vital to drive consensus and achieve positive outcomes. ESSENTIAL RESPONSIBILITIES Oversee departmental management, including involvement in hiring decisions, coaching, performance management, and operational organization. Develop and implement necessary policies and maintain budgetary responsibility as needed. Create comprehensive strategies for new reimbursement models, encompassing fee-for-service, pay-for-value, bundled payments, and risk-sharing initiatives, aiming to enhance quality while controlling costs. Develop a 3-5 year strategic roadmap outlining reimbursement designs, ensuring Highmark remains at the forefront of industry developments. Employ a Health Economist approach to evaluate and refine reimbursement models. Work with stakeholders to design targeted models that align with strategic enterprise initiatives and seek innovative enhancements through data evaluation and market research. Establish and nurture strategic provider relationships to gauge readiness for change, validate new programming concepts, and communicate market trends effectively with key partners and advocacy groups. Perform other duties as assigned or requested. EDUCATION Required Bachelor's Degree in Business, Finance, Healthcare Administration, or a related field. Preferred Master's Degree in Business or Healthcare Administration. EXPERIENCE Minimum 7 years in Healthcare, Healthcare Insurance, Consulting, or related fields. 3 years in value-based reimbursement and managed care contracting. 4 years in research and strategic planning for emerging trends in reimbursement and payment model design. To include: 1 year experience with technology vendors and service provider solutions. 2 years experience in a Health Economist role focusing on health trends. Preferred 5 years familiarity with alternative care model designs and reimbursement strategies. 5 years experience in health care service delivery quality metrics. 5 years in managing large cross-organizational projects. 5 years knowledge of health plan and provider contracting. 2 years understanding of provider contract management processes. LICENSES or CERTIFICATIONS Required None. Preferred None. SKILLS Strong written and verbal communication skills with the ability to convey complex concepts effectively. Proficient in managing multiple projects within established timelines. Autonomous decision-making in guiding reimbursement model creation from concept to execution. Deep analytical skills with a solid financial background related to healthcare economics. Ability to perform quick calculations in real-time, supporting swift decision-making. Travel Requirement: 0% - 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office-based, requiring regular travel to various work sites. Pay Range Minimum: $126,400.00 Pay Range Maximum: $236,000.00 Base pay is determined by a variety of factors including experience, qualifications, and market considerations. Highmark Health and its affiliates are committed to diversity and prohibit discrimination against qualified individuals based on veteran status, disabilities, or any protected category under applicable law. To contact us regarding website accessibility or application assistance, please reach out to HR Services. Req ID: J267196

Created: 2026-03-04