Director Strategy - Risk Adjustment

Highmark Health • PA, Working at Home - Pennsylvania, NV

1d • $142,000 - $236,000 • Hybrid

About The Position

The Director of Strategy for Risk Adjustment (Risk Adjustment Accuracy Management (RAAM)) plays a pivotal role in driving the strategic planning, operational efficiency, and programmatic execution within the RAAM department. This role is responsible for facilitating strategic initiatives, managing key projects, overseeing critical programs, and ensuring effective team coordination. The Director will act as a central point for managing performance reporting, budgetary oversight, and cross-functional engagement to optimize risk adjustment accuracy and achieve organizational goals.

Requirements

• Bachelor's Degree in Healthcare Administration, Finance, Economics, or related discipline or relevant experience and/or education as determined by the company in lieu of bachelor’s degree
• 3 years of experience in a management or leadership role
• 3 years of experience as a consultant/client-facing member of services business, or 4 years of strategy experience,
• 2 years of experience in a healthcare related field, preferably inside health or hospital system or health plan
• Understanding of the healthcare industry
• Ability to solve complex conceptual and operational problems; demonstrated ability to lead teams in problem-solving exercises
• Strong quantitative and analytical skills
• Demonstrated client relationship, influencing, and teamwork skills. Needs to be able to lead cross-functional, cross-BU teams in complex problem-solving exercises
• Basic project management skills
• Strong emotional intelligence, with servant leadership mind-set
• Commitment to self development and the development of others

Nice To Haves

• Master's Degree in Business or Public Health or an MD

Responsibilities

• Lead strategic planning cycles, facilitate goal-setting, and manage cross-functional processes within RAAM. This includes preparing and coordinating content for leadership reviews, facilitating strategy sessions, and developing/maintaining operational and project roadmaps.
• Oversee the coordination of all RAAM team activities, including meeting content development, communications, team-building initiatives, and serving as a key liaison for broader organizational engagement.
• Support and manage key cross-functional projects critical to RAAM's objectives, such as business case development, process reviews, regulatory response support, AI & transformational project planning/implementation, and integration planning/support.
• Provide strategic oversight and drive execution for significant RAAM programs, such as support for Clinical Programs that support Risk Adjustment accuracy and completeness (KPI monitoring, QA process development), Strategic Development and Growth of Internal Programs (scorecards, consultative support, operational enablement), and Product assessment gaps/needs with an aligned strategic and tactical plan to support implementation and/or performance improvement.
• Manage the RAAM budget, including purchase order approvals, budget development, oversight of accrual processes in conjunction with Finance/Accounting and identifying initiatives for spend reduction.
• 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; develops and implements policies and programs as necessary; may have budgetary responsibility and authority.
• 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.
• Manage major strategy projects with the help of internal or external strategy consulting resources.
• Supports Enterprise Strategy office in development of overall Enterprise Focus 5 strategy portfolio and cross-enterprise strategies as needed.
• Other duties as assigned or requested.

Benefits

• Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

What This Job Offers

• Job Type: Full-time
• Career Level: Director