Manager Strategic Risk Adjustment Programs

Highmark Health•Washington, NV

4d•$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 serving beneficiaries in Medicare Advantage and ACA government programs. The position applies capability analysis and definition, operating model development, incentive model design, governance and decision rights, process engineering, and metrics design to deliver value to the Health Plan and its beneficiaries. The Manager works with senior and executive leadership, physicians, technical staff, and strategic hospital partners to identify, prioritize, and deliver projects that advance business outcomes and strategic objectives. The role also supports the development of patient care delivery and Risk Adjustment documentation and reporting capabilities, drives continuous improvement, and coaches and mentors program team members. The position manages department operations and staff, leads program engagements and project teams, and regularly briefs Enterprise executive leadership on program strategy, performance, timelines, risks, and issues. It is office-based, with occasional travel from the office to work sites. The listed 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.
Skills in multitasking, analytical and logical reasoning, 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

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