Strategy Consultant - Risk Adjustment

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This job supports executive leadership of the Organization with a range of strategic initiatives, specifically focusing on the evolution of Risk Adjustment Accuracy Management (RAAM) and Highmark's clinical data strategy. Providing analytical/strategic-thinking and leading project teams, particularly those bridging business and technical functions, to: 1) isolate complex business issues related to RAAM and interoperability; 2) design and execute analytics for studying these issues (market research, scenario planning, forecasting, etc.); 3) develop technical content and serve as a subject matter expert on clinical data exchange, interoperability standards, and related technologies; 4) support development of formal recommendations to senior levels of Highmark leadership, ensuring solutions maximize business value and adhere to technical standards; 5) create documents (go-to-market or operational strategies, technical roadmaps, etc.) that inform critical strategic issues and decisions, and 6) execute the initiatives.

If you are within 50 miles of a Highmark office this role will be Hybrid onsite 3 days a week. T, W, Th. If you are outside of those 50 miles this role will be remote.

ESSENTIAL RESPONSIBILITIES

• 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.

• Serve as subject matter expert to Strategic Operations staff and stakeholders on membership, growth and operational strategy issues.

• 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.

EDUCATION

Required

• 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

Substitution

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

Preferred

• Extensive knowledge of Health Insurance and/or Provider operations, especially related to Risk Adjustment.

• Experience in operational improvement and process optimization.

LICENSES or CERTIFICATIONS

Required

• None

Preferred

• None

SKILLS

• Strong analytical and problem-solving skills.

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

• Knowledge of healthcare industry trends and challenges, especially in the context of interoperability.

• Hands-on experience working with and applying clinical data standards (FHIR, CDA, HL7, etc.).

• Experience leveraging data integration technologies and cloud platforms to address business needs.

• Proficiency in gathering and facilitating the translation of business requirements into technical requirements.

• Strong knowledge of healthcare IT security and privacy regulations (e.g., HIPAA).

• Strong critical thinking skills.

• Good communication and presentation skills across various audience levels.

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based

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

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:

$92,300.00

Pay Range Maximum:

$172,500.00

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 [email protected]

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Req ID: J273804