Company :

Job Description : 

JOB SUMMARY

This job supports leadership of the Risk Adjustment Accuracy Management (RAAM) department with a range of activities essential to RAAM’s program strategy and operational goals. Provide analytical/strategic-thinking and leadership support that enables project teams to: 1) isolate business issues; 2) design and execute analytics for studying business issues (market research, scenario planning, forecasting, market share, profitability, etc.); 3)

develop technical content (competitive intelligence, market trend analysis); 4) support development of formal recommendations to senior levels of Highmark leadership; 5) create documents (go-to-market or operational strategies, etc.) that inform critical strategic issues and decisions.

This role can be hybrid or remote. However if you live within 50 miles of an office you are required to be onsite 3 days a week. T, W, TH.

ESSENTIAL RESPONSIBILITIES

• Work with business/ market owners to identify key business issues, apply right analytical framework, develop solution and recommendations, represent findings to stakeholders and own the outcome.
• Lead the successful delivery of evolving risk adjustment initiatives and projects, driving outcomes directly aligned with RAAM's strategic plan
• Manage major strategy projects with the help of internal or external strategy consulting resources.
• Serve as subject matter expert to Strategic Operations staff and stakeholders on risk adjustment programs for Medicare Advantage, Medicaid, and ACA lines of business.
• Provide periodic informal work guidance/direction to junior team members; Provide performance input and recommendations to management for development/ training plans. May have supervisory responsibilities on a project basis.
• Develop analytical frameworks, approach and methodology best practices to analyze strategy issues.
• Other duties as assigned or requested.

EDUCATION

Required

• Masters Degree in Business, Healthcare, Economics or related degree
• 2 years of post-grad experience with strategy / management consulting firms (such as McKinsey, Boston Consulting Group, Booz & Company, Accenture (strategy Practice) or Deloitte (Strategy practice) ) or internal strategy groups of healthcare companies (such as Aetna, United Health Group, WellPoint, GE, )
• 6 years of related experience in Business or Healthcare

Substitution

• Bachelor's degree and 3 years of relevant progressive strategic experience in lieu of Master's degree

Preferred

• Extensive knowledge of Health Insurance and/or Provider operations

• Experience in operational improvement

• Extensive knowledge of government risk adjustment models, including CMS-HCC, HHS-HCC, and/or CDPS models

• Extensive experience in implementing and managing provider-facing and/or patient-facing programs for the purposes of ensuring complete and accurate risk documentation

• Through knowledge of membership, rates, financial, economic and competitive data

LICENSES or CERTIFICATIONS

Required

• None

Preferred

• None

SKILLS

• Broad application of principles, theories, and concepts in strategic thinking, plus working knowledge of other related fields
• Strong PC application Skills (MS Office including PowerPoint and Excel)
• Knowledge of healthcare industry trends and challenges
• Strong critical thinking skills
• Good communication and presentation skills

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based or Remote

Teaches / trains others regularly

Occasionally

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

Never

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

Never

Physical work site required

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Never

Lifting: 25 to 50 pounds

Never

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 job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
 

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:

Pay Range Maximum:

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.  The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

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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