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Added 10 mins ago
VC
Senior Director-Internal Audit (Network)
Verizon Corp Rsrcs Group LLC
Basking Ridge, NJ · Ashburn, VA · Lake Mary, FL
- $167,000 to $320,000 USD / year
Oversee the use of Quality Assurance and Improvement Program (QAIP) results to identify and implement areas of continuous improvement across the audit process.
Added 12 mins ago
Point of Entry Nurse | Transfer Center
HMH - Houston Methodist Hospital - The Methodist Hospital
United States
Graduate of education program approved by the credentialing body for the required credential(s) indicated below in the Certificates, Licenses and Registrations section
Added 13 mins ago
Patient Access Center Representative (PRN)
CORP - HM Corporate Division - The Methodist Hospital
United States
…of opportunities while providing innovative suggestions for process improvement. The Patient Access Center Representative position also assists management with auditing/quality review to…
Added 13 mins ago
Patient Access Center Representative (PRN)
CORP - HM Corporate Division - The Methodist Hospital
United States
…of opportunities while providing innovative suggestions for process improvement. The Patient Access Center Representative position also assists management with auditing/quality review to…
Added 13 mins ago
Nutrition Assistant
HMH - Houston Methodist Hospital - The Methodist Hospital
United States
…responsible for educating the patient on the dining services programs/process, is the initial point of contact for problem resolution, and assures that information regarding the diet is…
Added 13 mins ago
Manager Revenue Cycle
CORP - HM Corporate Division - The Methodist Hospital
United States
At Houston Methodist, the Manager Revenue Cycle position is responsible for the daily management of the staff and operations for one or more of the following areas of Revenue Cycle, to…
Added 13 mins ago
Manager Pharmacy Services
HMH - Houston Methodist Hospital - The Methodist Hospital
United States
At Houston Methodist, the Manager Pharmacy Services position is responsible for providing and assuring quality pharmaceutical care in accordance with accepted ethical and professional…
Added 14 mins ago
Clinical Research Nurse
HMRI - Houston Methodist Research Institute - The Methodist Hospital Research Institute
United States
Facilitates onboarding and orientation process for new staff in conjunction with Clinical Trials Manager. Precepts new clinical research staff in clinical setting. Implements staff…
Added 22 mins ago
Associate Director of Human Resources
St. Olaf
Northfield, MN
Lead the administration and continuous improvement of the College's performance management program, including annual evaluations, goal setting, ongoing feedback, and employee development.
Added 23 mins ago
IT Service Desk Specialist III
U.S. Urology Partners, LLC
Voorhees, NJ · Indianapolis, IN · Columbus, OH · Syracuse, NY · Palm Coast, FL
…that delivers efficient service delivery and drive continuous improvement to align IT support with business goals and customer satisfaction…
Added 24 mins ago
TD
Grants Manager
The Dream Program
Winooski, VT
- $55,000 to $72,000 USD / year
DREAM seeks a strategic, detail-oriented, and mission-driven Grant & Project Manager to help advance the organization's work to close the opportunity gap for children and teens through deep…
Added 26 mins ago
Interim HIM Manager
Citizens Health
Colby, KS
Accept and respond to constructive criticism and suggestions and strive for self-improvement.
Added 26 mins ago
HIM Manager
Citizens Health
Colby, KS
Accept and respond to constructive criticism and suggestions and strive for self-improvement.
Added 26 mins ago
Specialty Clinic Scheduler
Citizens Health
Colby, KS
Accept and respond to constructive criticism and suggestions and strives for self-improvement
Added 27 mins ago
CA
Contracts and Legal Operations Manager
Clean Air Task Force
Remote, United States
- $98,000 to $110,000 USD / year
The Contracts and Legal Operations Manager will support CATF’s General Counsel and work directly with program and operations teams on contracts, grants, compliance, and day-to-day legal…
Added 28 mins ago
Sr. Revenue Cycle Manager
RU Roseman University of Health Sciences
United States
The Senior Revenue Cycle Manager provides strategic and operational leadership for all revenue cycle functions within the College of Dental Medicine's clinics in Nevada and Utah. This role…
Added 29 mins ago
BL
UI/UX Designer
Banner Life family of companies
Remote, United States
- $109,900 to $140,000 USD / year
Own the design process from concept through development hand-off, preparing design specifications and assets in Figma and supporting engineers during build and testing to ensure the…
Added 30 mins ago
BT
Development Director
Booker T Washington Community Service Center
San Francisco, CA
- $140,000 to $150,000 USD / year
…will work alongside a high-achieving team consisting of the Program and Finance teams, while being supported by grant development…
Added 31 mins ago
Strategic Account Manager
Pacific Rim Capital
Irvine, CA
Improve continuously - identify opportunities to improve program efficiency, customer satisfaction, and portfolio performance through process improvements and operational recommendations.
Added 31 mins ago
Sr. Manufacturing Engineer
Ascend Performance Materials Operations LLC
Pensacola, FL
Work with Process Engineering to develop improvement projects and escalate issues requiring advanced analysis.
Added 31 mins ago
3rd Shift Molding Supervisor - Tier 1 Automotive Supplier
International Automotive Components
Arlington, TX
Engage in Continuous Improvement efforts, including 5S, 5 Whys, and 8-D documentation.
Added 32 mins ago
Proposal Writer/Manager
ShorePoint
Remote, United States
Contribute to post-proposal lessons learned and support process improvement.
Added 33 mins ago
Product Cybersecurity & Compliance Manager
Strattec Security Corp.
Auburn Hills, MI
Audits & Metrics: Track and report KPIs regarding process maturity and compliance health. Conduct periodic internal audits to drive continuous improvement and coordinate external…
Added 35 mins ago
Associate Product Owner
CCS
Remote, United States
As the Associate Product Owner, you will Support the vision, planning, and delivery of technology products and business process solutions. The vision includes the road-map for strategic…
Added 36 mins ago
P
Purchasing Manager
PARR
Hillsboro, OR
- $112,005 to $134,405 USD / year
The Purchasing Manager leads the Commodity and Hardlines Buying team while maintaining assigned product groups and vendor relationships as specified by the VP of Purchasing. This…

Closed listing

Highmark Health

Manager Strategic Risk Adjustment Programs

Santa Fe, NM, United States

This opening has closed.

The original listing is kept below for reference.

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Job details

Posting language: English
Posted: Nov 6, 2026

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Original job description

Archived listing. The details below describe a past opening.

Company :

Highmark Inc.

Job 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

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.

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:

$102,700.00

Pay Range Maximum:

$164,600.00

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.

California Consumer Privacy Act Employees, Contractors, and Applicants Notice (https://dokumfe7mps0i.cloudfront.net/oms/4391/document/2026/1/doclib_458575_QLVK9_1769448333304228022_1769448333396/1769448333396.pdf)

Req ID: J291267

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