Strategy Consultant, Risk Adjustment Analytics - Remote

Highmark Health

Montpelier (VT)

Hybrid

USD 109,000 - 181,000

Full time

14 days+

Application generator

Turn this role into an interview — a resume and cover letter built around what this employer wants.

Get past ATS filters

Job summary

Highmark Health is seeking an experienced leader to support the Risk Adjustment Accuracy Management (RAAM) department, guiding analytics, market research, forecasting, and competitive analyses to inform strategic decisions.

The role offers hybrid or remote work with onsite requirements 3 days a week if within 50 miles of an office. This leadership position requires advanced healthcare strategy experience and strong communication skills.

Qualifications

Masters Degree in Business, Healthcare, Economics or related degree.
2 years of post-grad experience with strategy/management consulting firms or internal strategy groups of healthcare companies.
6 years of related experience in Business or Healthcare.
Bachelor's degree and 3 years of relevant progressive strategic experience in lieu of Master's degree.
Extensive knowledge of Health Insurance and/or Provider operations.
Experience in operational improvement.
Extensive knowledge of government risk adjustment models, including CMS-HCC, HHS-HCC, and/or CDPS models.
Extensive experience in implementing and managing provider-facing and/or patient-facing programs for the purposes of ensuring complete and accurate risk documentation.
Through knowledge of membership, rates, financial, economic and competitive data.

Responsibilities

Work with business/ market owners to identify key business issues, apply right analytical framework, develop solution and recommendations, represent findings to stakeholders and own the outcome.
Lead the successful delivery of evolving risk adjustment initiatives and projects, driving outcomes directly aligned with RAAM's strategic plan
Manage major strategy projects with the help of internal or external strategy consulting resources.
Serve as subject matter expert to Strategic Operations staff and stakeholders on risk adjustment programs for Medicare Advantage, Medicaid, and ACA lines of business.
Provide periodic informal work guidance/direction to junior team members; Provide performance input and recommendations to management for development/ training plans. May have supervisory responsibilities on a project basis.
Develop analytical frameworks, approach and methodology best practices to analyze strategy issues.
Other duties as assigned or requested.