Director of Strategy - Risk Adjustment

Company

Highmark Inc.

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.

• 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, 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 the development/management of Provider-Led and Provider-Coordinated Healthcare Programs (performance management, expansion, new program development).

• 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.

This role is hybrid or remote - If you live within 50 miles of an office you will be hybrid 3 days a week onsite. T, W, Th. Outside of 50 miles will be remote.

• Perform management responsibilities to include, but 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.

• 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

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

• 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

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• 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…