Company. Highmark Inc. Job Description. JOB SUMMARY. This is a hybrid role if living within a 50 mile radius of a Highmark office (PA, NY, WV, DE). This job is responsible for activating solutions and ensuring that the intended value of each solution is achieved through thoughtful planning and execution. The incumbent will lead a cross functional group of matrix partners to develop sound business cases to support the realization of our solutions...
Company. Highmark Inc. Job Description. GENERAL OVERVIEW. This is a hybrid role asking 3 days a week in our Pittsburgh location. This job is responsible for the successful definition, implementation and delivery of complex programs that requires cross-functional collaboration and interdependencies between a group of projects and/or related activities within the constraint of scope, quality, time and budget and under circumstances involving multi...
Company. Highmark Inc. Job Description. JOB SUMMARY. . This job is responsible for managing a book of business and the business relationship as a strategic consultant for existing accounts directly or through intermediaries. The incumbent is responsible for renewing accounts and selling new products and services to existing accounts to ensure retention and growth of profitable business. ESSENTIAL RESPONSIBILITIES. Review new products, services, c...
Company. Highmark Inc. Job Description. JOB SUMMARY. The Associate Medical Record Retrieval Specialist is responsible for requesting and obtaining medical records from healthcare providers to ensure accurate documentation of members’ health conditions and optimize risk adjusted revenue for the organization. Primary duties include provider outreach, identifying and coordinating the most efficient retrieval methods with provider offices, and ensur...
Company. Highmark Inc. Job Description. JOB SUMMARY. This job leads a physician team and ensures that utilization management responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent oversees a team of Medical Directors who are responsible for reviewing escalated cases electronically and using Medical Policy criteria sets, evaluating the medical necessity and appropriateness of the requested ...
Company. Highmark Health. Highmark Health. Job Description. THIS POSTING IS INTENDED FOR PARTNERUP PROGRAM PARTICIPANTS ONLY. Sign on Bonus Eligible. Full Time and Part Time Opportunities available on various shifts at multiple hospital locations. Our Pittsburgh area locations include : Allegheny General Hospital, Forbes Hospital, Allegheny Valley Hospital, Wexford Hospital, West Penn Hospital, and Jefferson Hospital. GENERAL OVERVIEW. Completes ...
Company. Highmark Inc. Job Description. JOB SUMMARY. This job will deliver value to the Health Plan, and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA), using skills including but not limited to Hierarchical Condition Category (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, a...
Company. Highmark Inc. Job Description. JOB SUMMARY. This is a hybrid role requiring 3 days a week in office or at provider sites. This role supports the Southeastern PA market (SEPA) and will require local travel. This job is directly responsible for outcomes of providers contracted in the Organization's gain/risk share arrangements and is a highly skilled expert in practice transformation to achieve the specific targets set in the individual g...
Company. Highmark Inc. Job Description. JOB SUMMARY. This job works in close partnership with sales, marketing and product management to drive purchase and/or adoption of innovative Organization products and services (i.e. spending account, transparency, value based benefits, clinical platform, health advocate, etc). The incumbent plans and delivers client presentations in conjunction with sales, works with marketing and product to understand pro...
Company. Highmark Inc. Job Description. JOB SUMMARY. This job supervises and coordinates the day to day activities of the UM Intake Coordination team. The incumbent selects, develops and continuously coaches staff to the highest levels of performance. Motivates and team builds through the creation of a work environment and conditions that contribute to highest levels of performance. ESSENTIAL RESPONSIBILITIES. Perform management responsibilities...
Company. Highmark Inc. Job Description. JOB SUMMARY. Under the direction of the manager, consumer markets, the Assistant Sales Center Manager will coordinate and provide sales consultation. for all activity flowing through the Medicare Center. This person will work closely with the benefit consultants, delivery crews, and various internal departments to ensure cohesive flow from the customer's first impression to consultation, final sale, and fol...
Company. Highmark Inc. Job Description. JOB SUMMARY. Under the direction of the manager, consumer markets, the Assistant Sales Center Manager will coordinate and provide sales consultation. for all activity flowing through the Medicare Center. This person will work closely with the benefit consultants, delivery crews, and various internal departments to ensure cohesive flow from the customer's first impression to consultation, final sale, and fol...
