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Added 1 min ago
RS
Assistant Store Manager - (Perry HWY Tim Horton's) - Erie, PA
Reid Stores LLC
Erie, PA
- $20 to $22 USD / hour
…exhaustive but is the most accurate list for the current job. Management reserves the right to revise the job outline and require other tasks to be performed when the circumstances of the…
Added 4 mins ago
ServiceNow Project Manager
BRMi
UNAVAILABLE, VA · MD · FL · DC · WV
BRMi is seeking a ServiceNow Project Manager to support a large financial services client.
Added 4 mins ago
Forklift Operator
CTDI
Memphis, TN
Immediately report any incidents or accidents involving PIT equipment to a Supervisor/Manager.
Added 7 mins ago
HE
Project Manager (Project Assistant)
Higher Education Services Corporation
Albany, NY
- $100,671 to $126,875 USD / year
…services – including flagship programs like the Tuition Assistance Program (TAP), the Excelsior Scholarship, and other State scholarships. HESC awards nearly $1 billion in financial aid to…
Added 8 mins ago
Certified Medical Assistant, Blue Ridge Orthopedics-Anderson, FT, Days
Prisma Health-University Medical Group
Anderson, SC
This is a non-management job that will report to a supervisor, manager, director, or executive.
Added 8 mins ago
Patient Services Representative, Orthopedics-Patewood, FT, Days
Prisma Health-University Medical Group
Greenville, SC
…phone support as needed and outlined through cross training program. Screens visitors and responds to routine requests for information. Responsible for gathering, accurately coding and…
Added 8 mins ago
Patient Services Representative, Orthopedics-Patewood, FT, Days
Prisma Health-University Medical Group
Greenville, SC
…phone support as needed and outlined through cross training program. Screens visitors and responds to routine requests for information. Responsible for gathering, accurately coding and…
Added 8 mins ago
Certified Medical Assistant (CMA), Greenville OB/GYN, FT, Days
Prisma Health-University Medical Group
Greenville, SC
This is a non-management job that will report to a supervisor, manager, director, or executive.
Added 8 mins ago
SI
Critical Facilities Engineering Manager
Salute Inc.
Afton, TX
- $125,000 to $140,000 USD / year
The Critical Facilities Lead Engineer serves as the on-site technical and operational authority for all mission-critical infrastructure within the data center. Reporting to the Data Center…
Added 9 mins ago
Senior Design Manager, Project Architect
Suffolk
Boston, MA
Partner with the Project Manager as a peer project leader: the Project Manager leads fee, contract, schedule, staffing, change, risk, client management, and financial performance, while the…
Added 11 mins ago
Aviation Sales Manager
Smiths Group
Edgewood, MD
…solutions to airports across the US East Coast. The Aviation Sales Manager will own key airport, airline, and related accounts; develop and execute territory strategy; and work closely with…
Added 16 mins ago
WN
Physical Plant Building and Excavating
Willoway Nurseries, INC
Avon, OH
- $25 to $35 USD / hour
Safety – Engage with coworkers to reduce workplace accidents. Report any safety concerns to manager immediately.
Added 16 mins ago
Project Coordinator, Grid Strategy & Solutions
Southern Company
Atlanta, GA
…within Grid Strategy & Solutions. Reporting to the Project Manager for federal funding, this position supports the project managers and technical leads on the team while owning…
Added 16 mins ago
Safety Specialist (1st Shift)
Glovis EV Logistics America
Ellabell, GA
…LLC. This vital role involves collaborating closely with our management team to ensure the effective implementation of safety and security policies, procedures, and programs. We are seeking…
Added 17 mins ago
WI
Accounting Systems Manager
WALKER INC
Needham, MA
- $90,000 to $115,000 USD / year
The Accounting Systems Manager leads the administration, integration, and continuous improvement of Walker's financial and related business systems. Combining strong accounting knowledge…
Added 23 mins ago
T
Epic Radiant Analyst (Ex-Epic)
TEKsystems
Dallas, TX
- $85 to $95 USD / hour
…an analyst looking for long-term engagement, as the hiring manager has a proven track record of extending high-performing consultants and identifying additional projects to keep strong…
Added 24 mins ago
Sr Manager, Customer Experience Data Strategy /Database Owner
Reynolds American
United States
REYNOLDS AMERICAN has an exciting opportunity for a Sr Manager, Sr Manager, Customer Experience Data Strategy /Database Owner in Winston-Salem, NC
Added 24 mins ago
VH
Registered Nurse (Residential Rehabilitation Treatment Program)
Veterans Health Administration
Sheridan, WY
- $77,471 to $146,587 USD / year
…language, and provides oversight of the patient safe medication management…
Added 24 mins ago
VH
Secretary (OA)
Veterans Health Administration
Wichita, KS
- $50,460 to $72,644 USD / year
…responsible division and provides authorized administrative or technical information. When needed, gather relevant background details before connecting calls to the…
Added 24 mins ago
VH
Medical Support Assistant (Advanced)
Veterans Health Administration
Slidell, LA · New Orleans, LA · Hammond, LA · Baton Rouge, LA
- $45,409 to $59,031 USD / year
Added 24 mins ago
VH
Supervisory Pharmacy Technician
Veterans Health Administration
San Francisco, CA
- $102,818 to $133,671 USD / year
This position is responsible for the supervision of all pharmacy technical staff and trainees, it also requires to supervise and provide technical oversight to manage personnel and work…
Added 24 mins ago
OO
International Support Branch Chief
Office of the Secretary of the Interior
Reston, VA · Washington, DC
- $143,913 to $187,093 USD / year
Acquires and manages the necessary resources, including leadership support, financial resources, and key personnel, to support DOI program goals, and reduce overall organizational risk.
Added 24 mins ago
CN
Supervisory Embedded Integrated Prevention Coordinator
Commander, Navy Installations Command
Keyport, WA
- $100,602 to $117,370 USD / year
Ability to develop concepts in program management and implementation, requirements determination, policy development and supervisory skills.
Added 24 mins ago
TS
Public Notice - Contract Specialist (Direct Hire)
Transportation Security Administration
Springfield, VA
- $85,447 to $133,142 USD / year
…memoranda to document the negotiation process, cost/price analysis, technical evaluations, and other…
Added 24 mins ago
BO
SUPERVISORY CIVIL ENGINEER
Bureau of Reclamation
Lakewood, CO
- $140,239 to $182,316 USD / year
-Lead decision making, change management, and stakeholder communication to ensure mission success.

Highmark Health

Manager Strategic Risk Adjustment Programs

Jefferson City, MO, United States

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Job details

Posting language: English

Original job description

Summary

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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