Strategic Risk Adjustment Programs Leader

Highmark Health Company; Nashville (TN); On-site; USD 103,000 - 165,000; Full time

Job summary

Highmark Inc. seeks an experienced Program/PMO leader to manage end-to-end Risk Adjustment programs, delivering value to the Health Plan and its beneficiaries enrolled in risk-adjusted government programs.

You will partner with senior leaders, health partners, and clinicians to craft program scope, staffing, governance, and metrics, coach the team, and drive continuous improvement across engagements.

Qualifications

• 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

Responsibilities

• Lead 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

Multitasking

Analytical thinking

Information Technology

Enterprise Systems

Financial Statements

Education

Bachelor's degree

Six years experience in lieu of degree

Master's Degree

Job description

Highmark Inc. seeks an experienced Program/PMO leader to manage end-to-end Risk Adjustment programs, delivering value to the Health Plan and its beneficiaries enrolled in risk-adjusted government programs.

You will partner with senior leaders, health partners, and clinicians to craft program scope, staffing, governance, and metrics, coach the team, and drive continuous improvement across engagements.