Manager Strategic Risk Adjustment Programs

Highmark Health•Carolina, PA

2d•$102,700 - $164,600•Onsite

About The Position

This role provides end-to-end management, delivery, and support for new and existing Risk Adjustment Programs. The incumbent uses capability analysis and definition, operating model definition, incentive model design, governance and decision rights, process engineering, and metrics design to deliver value to the Health Plan and beneficiaries enrolled in risk-adjusted government programs, including Medicare Advantage (MA) and ACA programs. The position works closely with senior and executive leadership, physicians, technical staff across the Enterprise, and strategic hospital partners to identify, prioritize, and deliver projects that advance business outcomes and strategic objectives. It supports efforts to strengthen patient care delivery and risk adjustment documentation and reporting capabilities, drives continuous improvement, and provides professional coaching and mentoring to program team members. The manager also performs staff-management responsibilities, oversees department operations and policies, and may have budgetary responsibility and authority. The role is office-based and includes occasional travel between the office and work sites. The stated pay range is $102,700 to $164,600.

Requirements

Bachelor’s degree in Business Administration/Management or Computer and Information Science, or six years of relevant and progressive experience in lieu of a bachelor’s degree.
7–10 years of project/program management experience.
3–5 years of leadership experience.
3–5 years of risk revenue experience.
1–3 years of strategic planning experience.
Excellent multitasking skills.
Analytical and logical reasoning/thinking skills.
Knowledge of information technology, enterprise systems, and financial statements.

Nice To Haves

Master’s degree in Business Administration/Management or Mental Health Services.
3–5 years of healthcare industry experience.
1–3 years of consulting experience.
1–3 years of experience with cross-functional project teams.
Project Management Professional (PMP) certification.

Responsibilities

Perform management responsibilities, including involvement in hiring and termination decisions, coaching and development, rewards and recognition, performance management, and staff productivity.
Plan, organize, staff, direct, and control day-to-day department operations; develop and implement policies and programs as necessary; and potentially exercise budgetary responsibility and authority.
Lead day-to-day execution of Strategic Risk Adjustment Program engagements, taking ownership of deliverables, resources, and outcomes.
Develop the business case, scope, staffing, and incentive model for RPM engagements with providers on internal programs, including UDC, Internal Chart Retrieval, and RSA.
Lead and manage project team members and/or external consultants, implementing and managing changes and interventions to achieve project goals.
Coordinate with executive project sponsors and stakeholders to support clear, transparent communication and ongoing alignment on project objectives, activities, and outcomes.
Brief Highmark and Highmark Health executive leadership, including the CFO, EVP, Chief Actuary, and Vice President, on project strategy, performance, timelines, risks, and issues.
Evaluate risks to program goals and objectives and escalate them as appropriate.
Conduct periodic market reviews to understand industry-leading practices and drive continuous improvement in department approaches, methods, tools, and awareness of department capabilities.
Coach and mentor program team members.
Perform other duties as assigned or requested.