Job Description

Description

: 

JOB SUMMARY

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.

ESSENTIAL RESPONSIBILITIES

  • 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 transparentto 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.

    • EDUCATION

    Requied

  • Bachelor's Degree in Business Administration/Management or Computer and Information Science

    • Substitutions

  • Six (6) years relevant and progressive experience in lieu of Bachelor's degree

    • Preferred

  • Master's Degree in Business Administration/Management or Mental Health Services

    • EXPERIENCE

    Required

  • 7 - 10 years Project / Program Management

    • To Include

  • 3 - 5 years Leadership
  • 3 - 5 years Risk Revenue
  • 1 - 3 years Strategic Planning

    • Preferred

  • 3 - 5 years Healthcare Industry
  • 1 -3 years Consulting
  • 1 -3 years Cross-Functional Project Teams

    • LICENSES or CERTIFICATIONS

    Required

  • None

    • Preferred

  • Project Management Professional (PMP)

    • SKILLS

  • Excellent Multi-Tasker
  • Analytical and Logical Reasoning/Thinking
  • Information Technology
  • Enterprise Systems
  • Financial Statements

    • Language (Other than English)

    None

    Travel Requirement

    0% - 25%

    PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

    Position Type

    Office-Based

    Teaches / trains others regularly

    Occasionally

    Travel regularly from the office to various work sites or from site-to-site

    Occasionally

    Works primarily out-of-the office selling products/services (sales employees) 

    Rarely

    Physical work site required 

    Yes

    Lifting: up to 10 pounds

    Constantly

    Lifting: 10 to 25 pounds

    Occasionally

    Lifting: 25 to 50 pounds

    Rarely

    As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. 

    Pay Range Minimum:

    $92,300.00

    Pay Range Maximum:

    $172,500.00

    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.

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