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1 - 10 of 18 matches in 0.006 seconds
Director, Clinical & Service Quality (JC138969058)
Last Updated: 2019-05-18
Employer: Highmark Health
Location: Wilmington, DE

Company :

Gateway Health Plan

Job Description :

I. GENERAL OVERVIEW:

The Director, Clinical Outcomes will focus on ensuring enterprise-wide compliance with clinical and service quality requirements for mandatory quality accreditation and federal and multi-state regulations. Primary responsibility is to directly lead, professional consultant staff in the development, implementation…

Medicaid Compliance Officer (Director) - Delaware (JC134184042)
Last Updated: 2019-05-18
Employer: Highmark Health
Location: Wilmington, DE

Company :

Highmark Inc

Job Description :

JOB SUMMARY

This job oversees the Government Compliance Medicaid Team. Government Compliance is responsible for the implementation of the Medicaid Compliance program. The incumbent ensures the business is properly following the growing number of laws, regulations and other requirements set for by the…

Medical Director - Gateway Health Plan (Delaware) (JC140987462)
Last Updated: 2019-05-18
Employer: Highmark Health
Location: Wilmington, DE

Company :

Gateway Health Plan

Job Description :

JOB SUMMARY

This job plays a crucial role in the corporation’s success and works closely with all divisions and departments within the corporate structure to provide clinical consultation and support with regard to program development, compliance with accepted medical standards, and practitioner/provider…

VP, Executive Medical Director (GHP Clinical Services) (JC141613448)
Last Updated: 2019-05-18
Employer: Highmark Health
Location: Wilmington, DE

Company :

Gateway Health Plan

Job Description :

JOB SUMMARY

This job is accountable for the strategic direction, implementation and effective execution of physician-led functions within Clinical Services including, but not limited to, Utilization Review, Medical Policy, Member and Provider Appeals and Retrospective Review. In addition this leader will have…

Manager Clinical Care Coordination (JC138672863)
Last Updated: 2019-05-18
Employer: Highmark Health
Location: Wilmington, DE

Company :

Gateway Health Plan

Job Description :

General Summary:

This job manages and coordinates the supervisory staff that has accountability for the case management, medical review, utilization review, quality management and/or health education team and programs. Monitors and evaluates the operational performance of overall departmental direction, leveraging analytics, regional…

Senior Director Clinical Operation Care Coordinator (JC140709345)
Last Updated: 2019-05-18
Employer: Highmark Health
Location: Wilmington, DE

Company :

Gateway Health Plan

Job Description :

JOB SUMMARY

This job provides strategic direction by leading the effort to create and maintain program development, implementation and evaluation of the utilization management, case management, and disease management programs impacting health for individuals and populations. The initiatives incorporate the regulatory and…

Actuary - Commercial Markets (JC136765881)
Last Updated: 2019-05-18
Employer: Highmark Health
Location: Wilmington, DE

Company :

Highmark Inc

Job Description :

General Overview:

This job is an ASA Certified actuary position that initiates and leads the development of actuarial studies and analyses. Gives direction to less experienced staff and will represent the department’s perspectives and needs in cross disciplinary settings. The incumbent applies actuarial…

Provider Contract Negotiator (JC134183133)
Last Updated: 2019-05-18
Employer: Highmark Health
Location: Wilmington, DE

Company :

Highmark Bcbsd Inc.

Job Description :

General Overview :

Serve in a leadership role for all activities and develop strategies for contract negotiations that support departmental initiatives as well as Highmark’s corporate mission and objectives.

Essential Job Functions :

1.Lead negotiations of provider payment and contractual terms, with…

Medical Case Manager - Group Health Plan (GHP) (JC140668078)
Last Updated: 2019-05-18
Employer: Highmark Health
Location: Wilmington, DE

Company :

Gateway Health Plan

Job Description :

JOB SUMMARY

This job assures that members with complex medical and/or psycho-social needs have access to high quality, cost-effective health care. Assists in the holistic assessment, planning, arranging, coordinating, monitoring, evaluation of outcomes and activities necessary to facilitate member access to healthcare…

Medical Case Manager - GHP (JC140709348)
Last Updated: 2019-05-18
Employer: Highmark Health
Location: Wilmington, DE

Company :

Gateway Health Plan

Job Description :

I. GENERAL OVERVIEW:

Assure that members with complex medical and/or psycho social needs have access to high quality, cost-effective health care. Assist in the holistic assessment, planning, arranging, coordinating, monitoring, evaluation of outcomes and activities necessary to facilitate member access to…

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