Strategic Risk Adjustment Programs Lead

Highmark Health Company; Atlanta (GA); On-site; USD 120,000 - 150,000; Full time

Job summary

Highmark Inc. seeks an experienced Program/Project Manager to oversee end-to-end Risk Adjustment initiatives across MA and ACA programs.

You will partner with senior leadership, physicians, and technical staff to define operating models, design incentives, govern programs, and drive large-scale projects that improve patient care delivery and risk documentation. You will coach and mentor the program team, lead engagement delivery, develop business cases, and ensure alignment with objectives,

Qualifications

• Bachelor's Degree in Business Administration/Management or Computer and Information Science.
• Six (6) years relevant experience in lieu of Bachelor's degree.
• Master's Degree in Business Administration/Management or Mental Health Services.
• 7-10 years Project / Program Management
• 3-5 years Leadership
• 3-5 years Risk Revenue
• 1-3 years Strategic Planning
• 3-5 years Healthcare Industry
• 1-3 years Consulting
• 1-3 years Cross-Functional Project Teams
• Project Management Professional (PMP) preferred

Responsibilities

• Plan, organize, staff, direct and control day-to-day operations of the department; develop and implement policies; may have budgetary responsibility.
• Lead the day-to-day execution of Strategic Risk Adjustment Program engagements taking ownership of the engagement deliverables, resources, and outcomes.
• Develop the engagement business case, scope, staffing and incentive model for RPM engagement with Providers on internal programs (UDC, Internal Chart Retrieval and RSA).
• Lead and manage project team members and external consultants by implementing and managing changes to achieve goals.
• Communicate with executive sponsors to ensure alignment on objectives, activities and outcomes.
• Regularly brief executive leadership on program status, strategy, performance, timelines, risks and issues.

Skills

Excellent multi-tasker

Analytical reasoning

Information Technology

Enterprise systems

Financial statements

Education

Bachelor's degree in Business Administration/Management or Computer and Information Science

Master's degree in Business Administration/Management

Job description

Highmark Inc. seeks an experienced Program/Project Manager to oversee end-to-end Risk Adjustment initiatives across MA and ACA programs.

You will partner with senior leadership, physicians, and technical staff to define operating models, design incentives, govern programs, and drive large-scale projects that improve patient care delivery and risk documentation. You will coach and mentor the program team, lead engagement delivery, develop business cases, and ensure alignment with objectives,