highmark

Highmark Health is a national, blended health organization that includes one of America’s largest Blue Cross Blue Shield insurers and a growing regional hospital and physician network. Based in Pittsburgh, Pa., Highmark Health’s 35,000 employees serve millions of customers nationwide through the nonprofit organization’s affiliated businesses, which include Highmark Inc., Allegheny Health Network, HM Insurance Group, United Concordia Dental, HM Health Solutions and HM Home & Community Services. Highmark Health’s businesses proudly serve a broad spectrum of health-related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions.

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🏢 highmark

🏢 AmeriHealth Caritas

👥 5001-10000 Information Technology Health Care

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🔥 Manager Strategy & Execution (Remote)

Posted 5 days ago

📍 United States of America

💸 92300.0 - 172500.0 USD per year

🔍 Health Insurance

🔧 Requirements

Bachelor's degree or relevant experience and/or education as determined by the company.
Minimum 3 years of strategic leadership experience.
Minimum 3 years of program or operational management experience.
Minimum 3 years in a leadership role.

💡 Responsibilities

Lead overall department strategy as an individual contributor and manager.
Support executive leadership with strategic activities aligned with organizational goals.
Provide analytical support and strategic thinking for project teams to address business issues.
Design and execute analytics for market research, forecasting, and profitability assessment.
Develop technical content and formal recommendations for senior leadership.
Create documents that inform critical strategic decisions and support enterprise strategy execution.
Manage day-to-day operations, including hiring, coaching, and performance management.
Build relationships with strategic partners and key stakeholders for successful engagement.

LeadershipProject ManagementData AnalysisStrategic ManagementAnalytical SkillsChange Management

Posted 5 days ago

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🔥 Complex Case Manager RN - (Remote)

Posted 6 days ago

📍 United States of America

💸 57700.0 - 107800.0 USD per year

🔍 Health Insurance

🔧 Requirements

High School Diploma/GED is required; a Bachelor's Degree in Nursing is preferred.
7 years of clinical, case management, or health insurance experience is required.
Experience in managing multiple chronic conditions and advanced training in behavioral therapies is preferred.
RN license in specified states is required, and additional licenses must be obtained within 6 months.
Understanding of cultural competency is important.

💡 Responsibilities

Maintain oversight over specified panel of members through ongoing health assessments.
Identify and implement appropriate clinical interventions.
Create detailed care plans addressing members' needs with long and short-term goals.
Conduct outreach and support for behavior changes and care coordination.
Monitor and improve health outcomes for assigned members.
Ensure compliance with applicable business processes, regulations, and accreditation standards.

Posted 6 days ago

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🔥 Medical Case Manager - Remote (Harrisburg, PA area)

Posted about 1 month ago

📍 United States of America

💸 57700.0 - 107800.0 USD per year

🔍 Healthcare

🔧 Requirements

Bachelor’s degree in nursing or a Master’s degree in Social Work, Counseling, Education, or a related field.
3 years experience in Acute or Managed Care/experience with Medicaid or Medicare populations, or 5 years experience for Social Work.
Preferred experience with high-risk pregnant women or chronic conditions.
Bilingual English/Spanish language skills and Case Management Certification.

💡 Responsibilities

Ensure members with complex needs have access to high-quality, cost-effective healthcare.
Facilitate assessment, planning, coordination, monitoring, and evaluation of healthcare services.
Educate members on illness impacts and collaborate with healthcare providers to coordinate care.
Develop individualized care plans and adjust goals based on monitoring.
Participate in interdisciplinary meetings and maintain knowledge of community resources.

Posted about 1 month ago

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🔥 Part-Time Weekend Medical Director (Remote)

Posted about 2 months ago

📍 United States of America

🧭 Part-Time

💸 170000.0 - 342274.0 USD per year

🔍 Health Insurance

🔧 Requirements

Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) required.
5 years of experience in Clinical, Direct Patient care in settings like hospital, outpatient or private practice.
Preferred: 1 year in Medical Management with strong knowledge of the managed care industry.
Awarded Board Certification in specialty recognized by appropriate boards.
Active state medical licensure required.

💡 Responsibilities

Conduct electronic review of escalated cases to determine medical necessity and appropriateness.
Complete initial determination of cases, review appeals and grievances.
Compose clear rationales for member and provider notifications consistent with compliance standards.
Participate as a member of the CMDM multidisciplinary team and advise on high-risk cases.
Manage or participate in projects requiring physician expertise.

Project ManagementCompliance

Posted about 2 months ago

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