Healthcare Strategy Lead - RAAM & Risk (Remote)

Highmark Health; Northern (KY); Hybrid; USD 109,000 - 181,000; Full time

Job summary

Highmark Inc. seeks a strategic leader to support the Risk Adjustment Accuracy Management (RAAM) department. You will analyze business issues, design analytics, and develop formal recommendations for Highmark leadership to inform critical decisions.

The role may be hybrid or remote; onsite 3 days/week if near an office. You will lead evolving risk adjustment initiatives and mentor team members while working with Medicare, Medicaid, and ACA programs.

Qualifications

• Masters in Business, Healthcare, Economics or related; 2+ years strategy/consulting experience.
• Extensive knowledge of Health Insurance and provider operations.
• Experience with CMS-HCC, HHS-HCC, and/or CDPS risk adjustment models.
• Experience implementing provider- or patient-facing risk documentation programs.

Responsibilities

• Identify key business issues and apply analytical frameworks to develop solutions.
• Lead delivery of RAAM initiatives and strategic projects.
• Serve as SME on risk adjustment programs for Medicare Advantage, Medicaid, and ACA.
• Guide junior team members and support training plans.
• May supervise project-based teams.

Skills

Strategic thinking

MS Office

Healthcare knowledge

Critical thinking

Communication

Job description

Highmark Inc. seeks a strategic leader to support the Risk Adjustment Accuracy Management (RAAM) department. You will analyze business issues, design analytics, and develop formal recommendations for Highmark leadership to inform critical decisions.

The role may be hybrid or remote; onsite 3 days/week if near an office. You will lead evolving risk adjustment initiatives and mentor team members while working with Medicare, Medicaid, and ACA programs.