Job Description :
This job provides end-to-end management, delivery and support to new and existing Risk Adjustment Programs. The incumbent will deliver value to the Health Plan, and its beneficiaries enrolled in Risk Adjusted government programs (MA and ACA), using skills including, but not limited to: capability analysis and definition; operating model definition; incentive model design; governance and decision rights; process engineering, and metrics design. The incumbent works closely with senior/executive leadership, Physicians and technical staff within the Enterprise and within strategic hospital partners, to identify, prioritize, and deliver large and small scale projects that advance business outcomes and achieve strategic objectives relative to new and existing Risk Adjustment Programs. Supports other key objectives designed to build/strengthen patient care delivery and capture of Risk Adjustment documentation/ reporting capabilities, as well as driving continuous improvement efforts. Will be responsible for professional coaching and mentoring of program team members.
- 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; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
- Lead the day-to-day execution of Strategic Risk Adjustment Program engagements taking ownership of the engagement deliverables, resources, and outcomes.
- Develop the engagement business case, scope, staffing and incentive model for RPM engagement with Providers on internal programs (UDC, Internal Chart Retrieval and RSA).
- Lead and manage project team members and/or external consultants by implementing and managing changes and interventions to ensure project goals are achieved.
- Work closely with executive project sponsors and stakeholders to make communication easy and transparent to ensure ongoing alignment with project objectives, activities, and outcomes.
- Regularly brief the executive leadership of the Enterprise (both Highmark and Highmark Health), including CFO, EVP, Chief Actuary, and Vice President, on project status including program strategy, performance, timelines, risks, and issues.
- Evaluate risks to risk adjustment programs goals and objectives and escalate as appropriate.
- Conduct periodic market review to understand industry leading practices and drive continuous improvement in department approaches, methods, and tools and organizational awareness of department capabilities.
- Other duties as assigned or requested.
- Bachelor's Degree in Business Administration/Management or Computer and Information Science
- Six (6) years relevant and progressive experience in lieu of Bachelor's degree
- Master's Degree in Business Administration/Management or Mental Health Services
- 7 – 10 years Project / Program Management
- 3 – 5 years Leadership
- 3 – 5 years Risk Revenue
- 1 – 3 years Strategic Planning
- 3 – 5 years Healthcare Industry
- 1 -3 years Consulting
- 1 -3 years Cross-Functional Project Teams
- SAS and SQL: Foundational knowledge of database querying and programming languages to lead reporting team
- Healthcare Payor Experience, preferably with consulting experience
- Excellent written/ verbal communication
LICENSES or CERTIFICATIONS
- Project Management Professional (PMP)
- Excellent Multi-Tasker
- Analytical and Logical Reasoning/Thinking
- Information Technology
- Enterprise Systems
- Financial Statements
Language (Other than English)
0% – 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Teaches / trains others regularly
Travel regularly from the office to various work sites or from site-to-site
Works primarily out-of-the office selling products/services (sales employees)
Physical work site required
Lifting: up to 10 pounds
Lifting: 10 to 25 pounds
Lifting: 25 to 50 pounds
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
Referral Level Payout 3
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