Program Manager - Risk Adjustment

GENERAL OVERVIEW

We are seeking an enthusiastic and detail-oriented Program Manager to join our team, focusing on government programs related to risk adjustment activities. In this role, you will be instrumental in managing programs for external providers once they are enrolled and utilizing our solutions. Our current focus areas include Delaware (DE), West Virginia (WV), Pennsylvania (PA), and New York (NY) across various government lines of business, including Medicare Advantage (MA), Dual Eligible Special Needs Plans (DSNP), Medicaid, and Affordable Care Act (ACA).

The ideal candidate will possess foundational program management experience and demonstrate proficiency in data manipulation using Excel and creating compelling presentations with PowerPoint. Strong communication skills are essential, as you will be interacting directly with doctors' offices while also applying strategic thinking to program execution. This role requires an individual who can foster both independent work and effective teamwork among external providers. Experience with government programs is a key requirement.

ESSENTIAL RESPONSIBILITIES

• Work with management to assemble project teams and work groups to produce deliverables required to achieve the objectives of a defined corporate program.    Lead project managers and work group leaders in the development and maintenance of comprehensive plans for a defined corporate program.
• Organize, direct and coordinate cross-functional activities to focus corporate resources on the successful delivery and implementation of the desired results for a defined corporate program and/or strategic initiative.
• Work with the executive sponsor of a corporate program (VP or higher), and other management as required to achieve the objectives of a defined corporate program.   Acquire detailed understanding of the business objectives for an assigned area.
• Monitor and evaluate the progress, alignment and financial “health” of a cross-functional group of projects and related activities which together, constitutes a defined corporate program.  Direct corrective action as needed to maintain the viability of the program. If required - Report to the executive team/sponsor/steering committee on the progress, business impacts and strategies around the program(s).
• Assess risks that might jeopardize successful achievement of the desired results of a program, develop risk mitigation strategies and tactics, and implement risk mitigation plans.
• As needed - Partners with procurement to develop and execute strategies related to the service/asset contracts.
• As needed - Manages the vendor to the responsibilities outlined in the contract and statement of work.
• Other duties as assigned or requested.

EDUCATION
Minimum

• High School Diploma / GED

Substitutions

• None

Preferred

• Bachelor’s degree in Business Administration or Technology Management-related area of study
• MBA or Master’s Degree in Technology Management-related area of study

EXPERIENCE

Minimum

• 7 -10 years of work experience in project management or
• 7-10 years of work experience delivering business solutions using information technology

Preferred

• None

LICENSES/CERTIFICATIONS

Required

• None

Preferred

• PMP or Certification in Project Management

SCOPE OF RESPONSIBILITY 
Does this role supervise/manage other employees?         

No 

WORK ENVIRONMENT
Is Travel Required?
Yes         
 

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

Note: Job duties and responsibilities support separation of duties across multiple users

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:

Pay Range Maximum:

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.

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.

For accommodation requests, please contact HR Services Online at [email protected]

California Consumer Privacy Act Employees, Contractors, and Applicants Notice