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1 - 10 of 28 matches in 0.008 seconds
Actuary - Commercial Markets (JC136765881)
Last Updated: 2019-11-17
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…

VP, Executive Medical Director (GHP Clinical Services) (JC141613448)
Last Updated: 2019-11-17
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…

Senior Oracle Cloud PaaS Administrator (JC150579922)
Last Updated: 2019-11-17
Employer: Highmark Health
Location: Home, DE

Company :

Hm Health Solutions Inc.

Job Description :

JOB SUMMARY

This is a key opportunity to join our high-performing Financial Transformation Team, supporting the deployment and operation of Oracle’s Cloud-based Enterprise Performance Management (EPM) and Enterprise Resource Planning (ERP) software suites.

The ideal candidate will…

Manager, Clinical Care Coordination (JC150729715)
Last Updated: 2019-11-17
Employer: Highmark Health
Location: Home, DE

Company :

Highmark Bcbsd Inc.

Job Description :

JOB 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…

Manager - Audit & Advisory Services (Medicaid Government Com (JC150986446)
Last Updated: 2019-11-17
Employer: Highmark Health
Location: Wilmington, DE

Company :

Highmark Inc

Job Description :

GENERAL OVERVIEW:

+ The Medicaid Government Compliance department partners with business units to ensure compliance to rules, regulations, policies, and procedures of governmental and contractual entities. Additionally, Medicaid Government Compliance continuously monitors regulatory requirements and helps the organization to accomplish its objectives…

Provider Contract Negotiator (Hospital) (JC134183133)
Last Updated: 2019-11-17
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…

General Clerk (JC146015601)
Last Updated: 2019-11-17
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…

Data Modeling Analyst (JC147267891)
Last Updated: 2019-11-17
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…

Oncology Complex Case Manager RN (JC149238493)
Last Updated: 2019-11-17
Employer: Highmark Health
Location: Home, DE

Company :

Highmark Inc

Job Description :

JOB SUMMARY

This job has primary ownership and oversight over a specified panel of members that range in health status/severity and clinical needs. The incumbent assesses health management needs of the assigned member panel and utilizing data/analytics in conjunction with professional clinical judgement…

Case Manager - LTC (JC150579879)
Last Updated: 2019-11-17
Employer: Highmark Health
Location: Home, DE

Company :

Highmark Inc

Job Description :

This job serves as the single point of contact for members to coordinate all of the member’s care needs across the various service delivery systems and community supports. This is a full time community based position requiring frequent travel within the assigned territory…

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