Strategic Risk Adjustment Programs Lead

Highmark Health; City of Albany (NY); On-site; USD 120,000 - 160,000; Full time

Job summary

Highmark Inc. is seeking an experienced leader to manage end-to-end Risk Adjustment Programs, delivering value to Health Plan beneficiaries enrolled in MA and ACA programs.

You will guide capability analysis, operating model design, governance, and incentive structures; mentor teams and collaborate with executives, physicians, and partners to drive large-scale initiatives and continuous improvement in risk capture and reporting.

Qualifications

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

Responsibilities

• Lead day-to-day management and staff development within the department.
• Oversee engagement delivery and outcomes for Strategic Risk Adjustment Programs.
• Develop engagement business case, scope, staffing, and incentive model for RPM with Providers.
• Direct project teams and external consultants; implement changes to meet goals.
• Maintain clear, transparent communication with executive sponsors and stakeholders.
• Brief executive leadership on status, strategy, timelines, risks and issues.
• Evaluate risks to risk adjustment program goals and escalate as needed.
• Conduct market reviews to benchmark best practices and drive improvements.
• Perform other duties as assigned.

Skills

Excellent multi-tasking

Analytical reasoning

Information Technology

Enterprise systems

Financial statements

Education

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

Six years experience in lieu of Bachelor's degree

Master's degree in Business Administration/Management or Mental Health Services

Job description

Highmark Inc. is seeking an experienced leader to manage end-to-end Risk Adjustment Programs, delivering value to Health Plan beneficiaries enrolled in MA and ACA programs.

You will guide capability analysis, operating model design, governance, and incentive structures; mentor teams and collaborate with executives, physicians, and partners to drive large-scale initiatives and continuous improvement in risk capture and reporting.