Director Strategy - Risk Adjustment

Company :

Highmark Inc.

Job Description : 

JOB SUMMARY

The Director of Strategy for Risk Adjustment (Risk Adjustment Accuracy Management (RAAM)) plays a pivotal role in driving the strategic planning, operational efficiency, and programmatic execution within the RAAM department. This role is responsible for facilitating strategic initiatives, managing key projects, overseeing critical programs, and ensuring effective team coordination. The Director will act as a central point for managing performance reporting, budgetary oversight, and cross-functional engagement to optimize risk adjustment accuracy and achieve organizational goals.

Key Responsibilities:

• Strategic Planning & Management: Lead strategic planning cycles, facilitate goal-setting, and manage cross-functional processes within RAAM. This includes preparing and coordinating content for leadership reviews, facilitating strategy sessions, and developing/maintaining operational and project roadmaps.
• RAAM Team Coordination: Oversee the coordination of all RAAM team activities, including meeting content development, communications, team-building initiatives, and serving as a key liaison for broader organizational engagement.
• Strategic Project Management: Support and manage key cross-functional projects critical to RAAM's objectives, such as business case development, process reviews, regulatory response support, AI & transformational project planning/implementation, and integration planning/support.
• Program Execution & Oversight: Provide strategic oversight and drive execution for significant RAAM programs, such as support for Clinical Programs that support Risk Adjustment accuracy and completeness  (KPI monitoring, QA process development), Strategic Development and Growth of Internal Programs (scorecards, consultative support, operational enablement), and Product assessment gaps/needs with an aligned strategic and tactical plan to support implementation and/or performance improvement.
• Budget & Spend Management: Manage the RAAM budget, including purchase order approvals, budget development, oversight of accrual processes in conjunction with Finance/Accounting and identifying initiatives for spend reduction.

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; develops and implements policies and programs as necessary; may have budgetary responsibility and authority.
• 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.
• Manage major strategy projects with the help of internal or external strategy consulting resources.
• Supports Enterprise Strategy office in development of overall Enterprise Focus 5 strategy portfolio and cross-enterprise strategies as needed.
• Other duties as assigned or requested.

EDUCATION
Required

• Bachelor's Degree in Healthcare Administration, Finance, Economics, or related discipline or relevant experience and/or education as determined by the company in lieu of bachelor’s degree

Preferred

• Master's Degree in Business or Public Health or an MD

EXPERIENCE

Required

• 3 years of experience in a management or leadership role

• 3 years of experience as a consultant/client-facing member of services business, or 4 years of strategy experience,

• 2 years of experience in a healthcare related field, preferably inside health or hospital system or health plan

Preferred

• None

LICENSES AND CERTIFICATIONS

Required

• None

Preferred

• None

SKILLS

• Understanding of the healthcare industry

• Ability to solve complex conceptual and operational problems; demonstrated ability to lead teams in problem-solving exercises

• Strong quantitative and analytical skills

• Demonstrated client relationship, influencing, and teamwork skills.  Needs to be able to lead cross-functional, cross-BU teams in complex problem-solving exercises

• Basic project management skills

• Strong emotional intelligence, with servant leadership mind-set

• Commitment to self development and the development of others

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

Rarely

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

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 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:

$142,000.00

Pay Range Maximum:

$236,000.00

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.

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For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

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