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Added 1 min ago
BS
Dining Server- Part Time
Brightview Senior Living, LLC
Wakefield, MA
- $17 to $19.5 USD / hour
- Part-time
…(if applicable), nor does it include the value of our benefit program. Offers will consider factors like experience, qualifications, location, community size (if relevant),…
Added 1 min ago
Medical Assistant (MA) - Primary Care, Clinton
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Clinton, MI
Support quality improvement initiatives and disease management programs.
Added 1 min ago
Personal Shopper, Lead
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Report customer issues, shorts, overages, damages to store management immediately.
Added 1 min ago
CS
Community Support Specialist
Copper Shores Community Health Foundation
Hancock, MI
- $24 USD / hour
…environments. You'll provide hands-on support with parenting, household management, and everyday life challenges while connecting families with resources to help them succeed. WHAT WE…
Added 1 min ago
QD
Phlebotomist Representative I Hospital Part Time
Quest Diagnostics Inc
Reed City, MI
- Part-time
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Added 1 min ago
Food Service Director/Head Cook (summers off)
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Houghton, MI
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Added 1 min ago
Phlebotomist Representative I Hospital
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…through MyQuest for Education *Annual, no-cost health assessment program Blueprint for Wellness *and so much more! Represents the face of our company to patients within the hospital systems…
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Medical Assistant Obstetrics & Gynecology Bloomfield
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Added 1 min ago
Warehouse Supervisor, BlueOval Battery Park Michigan
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Added 1 min ago
Store Leader (Manager) Trainee
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Added 1 min ago
AD
AIS Radiologist (Remote)
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Remote, United States
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Added 1 min ago
Store Leader (Manager) Trainee
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…extra income. Fast forward through hard work, completion of our training programs, and really learning the business, it’s easy to see how we can boast about having the best store management…
Added 1 min ago
Senior Underwriting Consultant - Internal Auditor
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Remote, United States
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Added 1 min ago
Sr. Maintenance Technician
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Hazel Park, MI
Lead and mentor work plan for emergency repair of critical assets and training plans for Maintenance Technicians.
Added 1 min ago
UiPath Lead
CGI Technologies and Solutions, Inc.
MI
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Added 1 min ago
EW
Sales Associate - Optical Specialist - Part Time
Eyeglass World
Walker, MI
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Strong multitasking, time management and organizational skills (Required)
Added 1 min ago
Assoc Technical Instructor
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Warehouse Manager
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Manage staffing, scheduling, training, qualifications, performance management, and employee development.
Added 1 min ago
Population Health/Epidemiology Researcher, Foundational Sciences (Medical Faculty, Assistant Prof)
Central Michigan University
Mount Pleasant, MI
…candidate will establish an independent, externally funded research program while strengthening research capacity across the College. The faculty member will collaborate with population…
Added 1 min ago
Ford Racing Powertrain Procurement & Supply Chain Specialist
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Allen Park, MI
…controls, and elevate supplier performance through proactive KPI management and hands-on operational support. Ultimately, your work protects program timelines, stabilizes critical material…
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Ford Racing Powertrain Business Manager
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Vehicle discount program for employees and family members and management leases.
Added 1 min ago
Senior Procurement Closeout Specialist
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Sprightbulb guides successful organizational transformation and product management. Our agile-first, collaborative, non-prescriptive approach embraces uncertainty and focuses teams on doing…
Added 1 min ago
Lead Clinical Laboratory Scientist
Veterans Affairs, Veterans Health Administration
Wyoming, MI
Added 1 min ago
Program Manager
Triumvirate Environmental LLC
Brighton, MI
Program Manager Triumvirate Environmental, one of the largest environmental services firms in North America, is seeking a Program Manager for our Operations team in our Midwest region. As a…
Added 1 min ago
Medical Assistant - Obstetrics & Gynecology Genoa
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Support quality improvement initiatives and disease management programs.

Highmark Inc

Manager Strategic Risk Adjustment Programs

Remote, United States

$102,700.00

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Job details

Pay: $102,700.00
Posting language: English
Posted: Nov 5, 2026

Original job description

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 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.

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

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