Strategic Risk Adjustment Programs Lead

Highmark Health Company; Madison (WI); On-site; USD 110,000 - 150,000; Full time

Job summary

Highmark Inc. in Madison, Wisconsin, is seeking a seasoned program manager to lead end-to-end Risk Adjustment initiatives, shaping governance, incentive design, and engagement delivery with providers and internal teams.

The role partners with executive sponsors, physicians, and IT staff to drive value for the Health Plan and beneficiaries through continuous improvement and capability development, while mentoring project teams and ensuring strategic outcomes.

Qualifications

• Bachelor's Degree in Business Administration/Management or Computer and Information Science.
• Six (6) years relevant and progressive 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)

Responsibilities

• Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
• 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/or external consultants by implementing and managing changes and interventions to ensure project goals are achieved.
• Work closely with executive project sponsors and stakeholders to make communication easy and transparent to ensure ongoing alignment with project objectives, activities, and outcomes.
• Regularly brief the executive leadership of the Enterprise (both Highmark and Highmark Health), including CFO, EVP, Chief Actuary, and Vice President, on project status including program strategy, performance, timelines, risks, and issues.
• Evaluate risks to risk adjustment programs goals and objectives and elevate as appropriate.
• Conduct periodic market review to understand industry leading practices and drive continuous improvement in department approaches, methods and tools and organizational awareness of department capabilities.
• Other duties as assigned or requested.

Skills

Excellent Multi-Tasker

Analytical and Logical Reasoning/Think

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 or Mental Health Services

Job description

Highmark Inc. in Madison, Wisconsin, is seeking a seasoned program manager to lead end-to-end Risk Adjustment initiatives, shaping governance, incentive design, and engagement delivery with providers and internal teams.

The role partners with executive sponsors, physicians, and IT staff to drive value for the Health Plan and beneficiaries through continuous improvement and capability development, while mentoring project teams and ensuring strategic outcomes.