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1 - 10 of 27 matches in 0.006 seconds
VP, Executive Medical Director (GHP Clinical Services) (JC141613448)
Last Updated: 2019-10-17
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…

Mgr Quality Improvement (JC142568288)
Last Updated: 2019-10-17
Employer: Highmark Health
Location: Wilmington, DE

Company :

Gateway Health Plan

Job Description :

JOB SUMMARY

This job, with oversight from the Director, is responsible for leading the strategic planning, development, implementation and monitoring of the quality portion of the Quality Improvement/Utilization Management Program and Work Plan Initiate (within all Gateway Health Plan SM Departments) collaborative…

Clinical Quality Management Analyst (JC142568307)
Last Updated: 2019-10-17
Employer: Highmark Health
Location: Wilmington, DE

Company :

Gateway Health Plan

Job Description :

JOB SUMMARY

This job works with appropriate departments in the areas of compliance, process improvement and member/provider satisfaction for all product lines. Reviews, researches and responds to customer complaints relating to quality of medical care and service. Recommends and/or implements process improvements…

Actuary - Commercial Markets (JC136765881)
Last Updated: 2019-10-17
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…

Director, Clinical & Service Quality (JC138969058)
Last Updated: 2019-10-17
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…

Medical Case Manager - GHP (JC145116743)
Last Updated: 2019-10-17
Employer: Highmark Health
Location: Home, DE

Company :

Gateway Health Plan

Job Description :

I. GENERAL OVERVIEW:

Assure that members with complex medical and/or psychosocial 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 healthcare…

General Clerk (JC146015601)
Last Updated: 2019-10-17
Employer: Highmark Health
Location: Wilmington, DE

Company :

Highmark Bcbsd Inc.

Job Description :

GENERAL OVERVIEW:

The General Clerk performs clerical support for functional groups in accordance with standard procedures, such as copying, preparing and distributing mail, inventory, data entry, filing, faxing and retrieving documents, indexing and scanning/imaging documents. May also include, performing calculations, compiling…

Clinical Quality Management Analyst (JC141757728)
Last Updated: 2019-10-17
Employer: Highmark Health
Location: Wilmington, DE

Company :

Gateway Health Plan

Job Description :

JOB SUMMARY

This job works with appropriate departments in the areas of compliance, process improvement and member/provider satisfaction for all product lines. Reviews, researches and responds to customer complaints relating to quality of medical care and service. Recommends and/or implements process improvements…

Data Modeling Analyst (JC147267891)
Last Updated: 2019-10-17
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…

Provider Contract Negotiator (Hospital) (JC134183133)
Last Updated: 2019-10-17
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…

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