Strategic Risk Adjustment Programs Lead

Highmark Health Company; Providence (RI); Sur place; USD 103 000 - 165 000; Plein temps

Résumé du poste

Highmark Inc. is seeking an experienced professional to lead end-to-end risk adjustment programs, delivering value to the health plan and beneficiaries enrolled in MA and ACA.

You will collaborate with senior leadership, physicians, and technical staff to identify priorities and drive large-scale projects. The role involves mentoring project teams, developing business cases, and overseeing governance, with accountability for program strategy, timelines, risks, and outcomes.

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.
• 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.

Responsabilités

• 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.
• 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.

Connaissances

Excellent Multi-Tasker

Analytical and Logical Reasoning/Think

Information Technology

Enterprise Systems

Financial Statements

Formation

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

Description du poste

Highmark Inc. is seeking an experienced professional to lead end-to-end risk adjustment programs, delivering value to the health plan and beneficiaries enrolled in MA and ACA.

You will collaborate with senior leadership, physicians, and technical staff to identify priorities and drive large-scale projects. The role involves mentoring project teams, developing business cases, and overseeing governance, with accountability for program strategy, timelines, risks, and outcomes.