Program Manager - Risk Adjustment

Highmark Health•Washington, DC

About The Position

GENERAL OVERVIEW We are seeking an enthusiastic and detail-oriented Program Manager to join our team, focusing on government programs related to risk adjustment activities. In this role, you will be instrumental in managing programs for external providers once they are enrolled and utilizing our solutions. Our current focus areas include Delaware (DE), West Virginia (WV), Pennsylvania (PA), and New York (NY) across various government lines of business, including Medicare Advantage (MA), Dual Eligible Special Needs Plans (DSNP), Medicaid, and Affordable Care Act (ACA). The ideal candidate will possess foundational program management experience and demonstrate proficiency in data manipulation using Excel and creating compelling presentations with PowerPoint. Strong communication skills are essential, as you will be interacting directly with doctors' offices while also applying strategic thinking to program execution. This role requires an individual who can foster both independent work and effective teamwork among external providers. Experience with government programs is a key requirement.

Requirements

Minimum High School Diploma / GED
7 -10 years of work experience in project management or 7-10 years of work experience delivering business solutions using information technology
Experience with government programs

Nice To Haves

Bachelor’s degree in Business Administration or Technology Management-related area of study
MBA or Master’s Degree in Technology Management-related area of study
PMP or Certification in Project Management

Responsibilities

Work with management to assemble project teams and work groups to produce deliverables required to achieve the objectives of a defined corporate program.
Lead project managers and work group leaders in the development and maintenance of comprehensive plans for a defined corporate program.
Organize, direct and coordinate cross-functional activities to focus corporate resources on the successful delivery and implementation of the desired results for a defined corporate program and/or strategic initiative.
Work with the executive sponsor of a corporate program (VP or higher), and other management as required to achieve the objectives of a defined corporate program.
Acquire detailed understanding of the business objectives for an assigned area.
Monitor and evaluate the progress, alignment and financial “health” of a cross-functional group of projects and related activities which together, constitutes a defined corporate program.
Direct corrective action as needed to maintain the viability of the program.
If required - Report to the executive team/sponsor/steering committee on the progress, business impacts and strategies around the program(s).
Assess risks that might jeopardize successful achievement of the desired results of a program, develop risk mitigation strategies and tactics, and implement risk mitigation plans.
As needed - Partners with procurement to develop and execute strategies related to the service/asset contracts.
As needed - Manages the vendor to the responsibilities outlined in the contract and statement of work.
Other duties as assigned or requested.