Manager, Strategic Risk Adjustment Programs

Highmark Health

. Provide end-to-end management, delivery and support to new and existing Risk Adjustment Programs .

Posted 11/5/2026full-timeUnited StatesSeniorLead💰 $102,700 - $164,600 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in managing Risk Adjustment Programs, including capability analysis, process engineering, and strategic planning. Proven ability to lead cross-functional teams, drive continuous improvement, and ensure compliance with healthcare regulations.

Highest-signal resume keywords

Project ManagementRisk Revenue ManagementStrategic PlanningHealthcare Industry ExperienceLeadership

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Capability AnalysisProcess EngineeringMetrics DesignGovernanceIncentive Model DesignProject DeliveryPerformance ManagementMarket ReviewDecision RightsContinuous Improvement

Soft Skills

CoachingMentoringMulti-TaskingAnalytical ThinkingLogical Reasoning

Tools & Technologies

Enterprise SystemsInformation TechnologyFinancial Statements

Certifications & Qualifications

Project Management Professional (PMP)

Industry Keywords

Risk Adjustment ProgramsHealthcare ComplianceHIPAAGovernment ProgramsCross-Functional Teams

Tech Stack

Tools & technologies

PMP

About the role

Key responsibilities & impact

Provide end-to-end management, delivery and support to new and existing Risk Adjustment Programs
Deliver value to the Health Plan and beneficiaries enrolled in Risk Adjusted government programs (MA and ACA)
Perform capability analysis and definition, operating model definition, incentive model design, governance and decision rights, process engineering, and metrics design
Work with senior/executive leadership, physicians, technical staff, and strategic hospital partners to identify, prioritize, and deliver projects
Support objectives that strengthen patient care delivery and capture Risk Adjustment documentation and reporting capabilities
Drive continuous improvement efforts
Coach and mentor program team members
Make hiring and termination decisions, coach and develop staff, manage performance and productivity, and oversee rewards and recognition
Plan, organize, staff, direct, and control day-to-day department operations; develop and implement policies and programs
Lead execution of Strategic Risk Adjustment Program engagements and own deliverables, resources, and outcomes
Develop engagement business cases, scope, staffing, and incentive models for RPM provider engagements and internal programs
Lead project team members and external consultants, managing changes and interventions to achieve project goals
Collaborate with executive sponsors and stakeholders to maintain alignment on objectives, activities, and outcomes
Brief executive leadership, including CFO, EVP, Chief Actuary, and Vice President, on strategy, performance, timelines, risks, and issues
Evaluate and escalate risks to program goals and objectives
Conduct market reviews to identify industry-leading practices and improve departmental approaches, methods, tools, and organizational awareness
Perform other duties as assigned

Requirements

What you’ll need

Bachelor's Degree in Business Administration/Management or Computer and Information Science
Six (6) years relevant and progressive experience in lieu of Bachelor's degree
7 - 10 years Project / Program Management
3 - 5 years Leadership
3 - 5 years Risk Revenue
1 - 3 years Strategic Planning
Preferred: 3 - 5 years Healthcare Industry
Preferred: 1 -3 years Consulting
Preferred: 1 -3 years Cross-Functional Project Teams
Required licenses or certifications: None
Preferred: Project Management Professional (PMP)
Excellent Multi-Tasker
Analytical and Logical Reasoning/Thinking
Information Technology
Enterprise Systems
Financial Statements
Travel requirement: 0% - 25%
Must comply with HIPAA, data security guidelines, company policies, applicable laws, and training requirements