Strategy Consultant - Risk Adjustment Accuracy

Company :

Highmark Inc.

This job supports leadership of the Risk Adjustment Accuracy Management (RAAM) department with a range of activities essential to RAAM’s program strategy and operational goals. Provide analytical/strategic-thinking and leadership support that enables project teams to:
1) isolate business issues;
2) design and execute analytics for studying business issues (market research, scenario planning, forecasting, market share, profitability, etc.);
3)

develop technical content (competitive intelligence, market trend analysis);
4) support development of formal recommendations to senior levels of Highmark leadership;
5) create documents (go-to-market or operational strategies, etc.) that inform critical strategic issues and decisions.

• 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.

• Lead the successful delivery of evolving risk adjustment initiatives and projects, driving outcomes directly aligned with RAAM's strategic plan

• Manage major strategy projects with the help of internal or external strategy consulting resources.

• Serve as subject matter expert to Strategic Operations staff and stakeholders on risk adjustment programs for Medicare Advantage, Medicaid, and ACA lines of business.

• Provide periodic informal work guidance/direction to junior team members;
  Provide performance input and recommendations to management for development/ training plans. May have supervisory responsibilities on a project basis.

• Develop analytical frameworks, approach and methodology best practices to analyze strategy issues.

• Other duties as assigned or requested.

• Masters Degree in Business, Healthcare, Economics or related degree

• 2 years of post-grad experience with strategy / management consulting firms (such as McKinsey, Boston Consulting Group, Booz & Company, Accenture (strategy Practice) or Deloitte (Strategy practice) ) or internal strategy groups of healthcare companies (such as Aetna, United Health Group, WellPoint, GE, )

• 6 years of related experience in Business or Healthcare

• Bachelor's degree and 3 years of relevant progressive strategic experience in lieu of Master's degree

Extensive knowledge of Health Insurance and/or Provider operations

Experience in operational improvement

• Extensive knowledge of government risk adjustment models, including CMS-HCC, HHS-HCC, and/or CDPS models

Extensive experience in implementing and managing provider-facing and/or patient-facing programs for the purposes of ensuring complete and accurate risk documentation

Through knowledge of membership, rates, financial, economic and competitive data

• None

• None

• Broad application of principles, theories, and concepts in strategic thinking, plus working knowledge of other related fields

• Strong PC application Skills (MS Office including PowerPoint and Excel)

• Knowledge of healthcare industry trends and challenges

• Strong critical thinking skills

• Good communication and presentation skills

None

0% - 25%

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

Never

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

Never

Lifting: 25 to 50 pounds

Never

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.

This job adheres to the ethical and legal standards…