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1 - 10 of 13 matches in 0.015 seconds
Medicaid Compliance Officer (Director) - Delaware (JC134184042)
Last Updated: 2019-04-24
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…

Director, Clinical & Service Quality (JC138969058)
Last Updated: 2019-04-24
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…

Manager Clinical Care Coordination (JC138672863)
Last Updated: 2019-04-24
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…

Actuary - Commercial Markets (JC136765881)
Last Updated: 2019-04-24
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…

Chief Medical Officer (Delaware) - Gateway Health Plan (JC134184157)
Last Updated: 2019-04-24
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…

Provider Contract Negotiator (JC134183133)
Last Updated: 2019-04-24
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…

Director Clinical Operations (JC138488497)
Last Updated: 2019-04-24
Employer: Highmark Health
Location: Wilmington, DE

Company :

Gateway Health Plan

Job Description :

JOB SUMMARY

This job provides assistance with clinical leadership and administrative oversight, program development, implementation and evaluation of the Long Term Services and Supports (LTSS) department impacting health for individuals and qualified populations. These initiatives incorporate the development and monitoring…

Associate Customer Service Representative (JC139816984)
Last Updated: 2019-04-24
Employer: Highmark Health
Location: Wilmington, DE

Company :

Highmark Bcbsd Inc.

Job Description :

GENERAL OVERVIEW

Handles customer inquiries by telephone and/or email and/or in person from individual members, groups, providers and brokers in a customer service center. Troubleshoots and resolves customer complaints. Ensures that responses to inquiries are completed timely and according to established service…

Data Modeling Analyst (JC139981195)
Last Updated: 2019-04-24
Employer: Highmark Health
Location: Wilmington, DE

Company :

Hm Health Solutions Inc.

Job Description :

Communicate with application developers, end-users, and database analysts to develop, maintain, and gain approval of data models of various levels of abstraction describing the data assets and business rules used by the corporation’s business concepts, business processes, and business applications. Develop…

Manager of Medicaid Risk Adjustment (JC138896646)
Last Updated: 2019-04-24
Employer: Highmark Health
Location: Wilmington, DE

Company :

Gateway Health Plan

Job Description :

JOB SUMMARY

This job is responsible for creating plans and managing activities in support of governmental products where risk adjustment methodologies apply. Directs the daily activities of direct reports supporting risk adjustment programs and activities. Assesses viability of current direction/projects/operations and recommends…

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