Strategic Risk-Adjustment Lead

Highmark Health; Denver (CO); Hybrid; USD 109,000 - 181,000; Full time

Job summary

Highmark Health is seeking a senior-level strategist to lead the RAAM program, providing analytical and leadership support to drive risk adjustment initiatives and strategic projects. The role involves working with market owners, guiding analytics, and presenting recommendations to senior leadership.

Hybrid/remote work is possible; onsite 3 days a week if within 50 miles of an office. Strong background in healthcare strategy and risk adjustment essential.

Qualifications

• Master's degree in Business, Healthcare, Economics or related field.
• 2 years of post-grad experience with strategy/management consulting firms or internal healthcare strategy groups.
• 6 years of related experience in business or healthcare.
• Bachelor's degree plus 3 years of relevant strategic experience may substitute for a Master's.
• Preferred: extensive knowledge of health insurance and provider operations.
• Knowledge of CMS risk adjustment models (CMS-HCC, HHS-HCC, CDPS).
• Experience implementing provider- and patient-facing risk documentation programs.
• Strong analytical and communication skills.

Responsibilities

• Identify key business issues with owners and recommend solutions.
• Lead delivery of risk adjustment initiatives aligned to RAAM's plan.
• Manage major strategy projects with internal or external resources.
• Serve as SME on Medicare Advantage, Medicaid and ACA risk programs.
• Provide coaching and development input to junior staff.
• Develop analytic frameworks and best practices for strategy issues.
• Perform other duties as assigned.

Skills

Analytical thinking

MS Office

Healthcare trends

Critical thinking

Communication

Education

Master's degree in Business/Healthcare/Economics

2 years post-grad strategy/consulting experience

6 years related experience in Business/Healthcare

Bachelor's +3 years substitution

Job description

Highmark Health is seeking a senior-level strategist to lead the RAAM program, providing analytical and leadership support to drive risk adjustment initiatives and strategic projects. The role involves working with market owners, guiding analytics, and presenting recommendations to senior leadership.

Hybrid/remote work is possible; onsite 3 days a week if within 50 miles of an office. Strong background in healthcare strategy and risk adjustment essential.