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1 - 10 of 35 matches in 0.012 seconds
Nurse Case Manager (JC147495343)
Last Updated: 2019-09-16
Employer: Highmark Health
Location: Home, DE

Company :

Highmark Inc

Job Description :

JOB SUMMARY

This job is the primary clinician managing members wide range in health status/severity and clinical needs in either a case management or condition (disease) management program. The incumbent will be responsible for assessing health management needs of the assigned members and…

VP, Executive Medical Director (GHP Clinical Services) (JC141613448)
Last Updated: 2019-09-16
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: 2019-09-16
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: 2019-09-16
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…

Clinical Care Coordinator, Behavioral Health (JC147267872)
Last Updated: 2019-09-16
Employer: Highmark Health
Location: Home, DE

Company :

Gateway Health Plan

Job Description :

This job works directly with providers in a variety of health care settings to appropriately identify members with chronic conditions and/or gaps in care that can be positively impacted related to quality and care costs. The incumbent’s responsibilities could include working in…

Actuary - Commercial Markets (JC136765881)
Last Updated: 2019-09-16
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: 2019-09-16
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: 2019-09-16
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…

Senior Clinical Training Specialist (JC145311768)
Last Updated: 2019-09-16
Employer: Highmark Health
Location: Home, DE

Company :

Gateway Health Plan

Job Description :

JOB SUMMARY

This job delivers highly complex clinical and systems training courses, ongoing workshops in support of workforce development, technology and/or proprietary business systems, updates or creates course materials to reflect changes in processes or systems and manages the department training effectively…

Medical Case Manager - GHP (JC145343109)
Last Updated: 2019-09-16
Employer: Highmark Health
Location: New Castle, DE

Company :

Gateway Health Plan

Job Description :

JOB SUMMARY

This job assures that members with complex medical and/or psychosocial 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…

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