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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
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🏢 CrowdStrike
👥 5001-10000💰 $4,600,000 Post-IPO Equity about 2 years agoComputer and Network Security
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🔥 RN Nurse Navigator - Remote
Posted 5 days ago

📍 United States of America

💸 30.82 - 48.21 USD per hour

🔍 Healthcare

  • Registered Nurse required.
  • 1-3 years nursing experience in the specialty required.
  • CPR certification from the American Heart Association.
  • Act 34 Criminal Background Clearance Certificate.
  • Act 33 Child Abuse Clearance Certificate.
  • Act 73 FBI Fingerprinting Criminal Background Clearance Certificate.
  • Bachelor's Degree in Nursing preferred.
  • Certification in area of expertise preferred.

  • Serves as a consistent point of contact for patients and their families.
  • Facilitates patient flow and coordinates appointments within the Network.
  • Works with the multidisciplinary team to ensure quality care for adult patients.
  • Educates patients on diagnoses, treatment options, and available resources.
  • Oversees community outreach and works with high-risk populations.
  • Trends data to improve patient care and identifies gaps.
  • May assist with bereavement needs and attend clinical care conferences.
Posted 5 days ago
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🔥 Clinical Transformation Consultant (Remote)
Posted 8 days ago

📍 Pennsylvania, Maryland, Washington, North Carolina, Louisiana, Kentucky, Kansas, Indiana, Illinois, Georgia, Iowa, Florida, Colorado, California, Delaware, Connecticut, Arkansas, Arizona, Alabama, Alaska, Nevada, Vermont, Idaho, Tennessee, Oklahoma, Hawaii, Mississippi, Utah, New Hampshire, New Mexico, Wyoming, North Dakota, South Dakota, Rhode Island, West Virginia, Montana, Texas, District of Columbia, Ohio, New Jersey, Oregon, South Carolina, Missouri, Virginia, Massachusetts, Nebraska, Minnesota, Michigan, Wisconsin, New York, Maine

💸 57700.0 - 106700.0 USD per year

🔍 Healthcare

  • Bachelor's Degree in a clinical or business discipline or equivalent experience.
  • 5-7 years of experience in healthcare, including clinical operations or management.
  • Knowledge of health plan provider network performance management.
  • Preferred MBA, MPH, or master's degree in a clinical field.
  • Experience in managed care or clinical settings preferred.
  • Formal Lean Six Sigma or process improvement training is a plus.

  • Provide hands-on consultative and training services to network providers.
  • Conduct performance analysis and gap assessments.
  • Develop transformation plans and collaborative relationships.
  • Lead implementation of provider projects and initiatives.
  • Ensure delivery of recommendations for clinical transformation.
  • Identify opportunities to enhance provider performance visibility.
  • Solve business problems related to change management.

Project ManagementData AnalysisClient relationship managementProcess improvementChange Management

Posted 8 days ago
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🔥 Complex Case Manager RN (Remote)
Posted about 1 month ago

📍 United States of America

🧭 Full-Time

💸 57700 - 106700 USD per year

🔍 Health Insurance

  • High School Diploma/GED required; Bachelor's Degree in Nursing preferred.
  • 7 years of clinical, case management, or health insurance experience required.
  • Advanced training in cognitive behavioral therapy, motivational interviewing, or dialectical behavior therapy preferred.
  • RN license in PA, WV, DE, or NY required; other state licenses must be obtained within 6 months.

  • Maintain oversight over specified panel of members by ongoing assessment of health management needs and identifying clinical interventions.
  • Create care plans addressing members' needs with long and short term goals, and plan of regular contacts for re-assessment.
  • Ensure achievement of patient goal metrics and maintain compliance with documentation and regulatory standards.
  • Support members in overcoming barriers and coordinating care through outreach and resource identification.

NegotiationPresentation skillsTime ManagementComplianceNegotiation skills

Posted about 1 month ago
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🔥 Senior Software Engineer - ML Engineer – AI Platforms and Services
Posted about 2 months ago

📍 United States of America

🧭 Full-Time

💸 78900 - 146000 USD per year

🔍 Healthcare

  • Bachelor's Degree in Computer Science, Computer Engineering or a closely related field.
  • 5 years proficiency in the design and analysis of algorithms and data structures.
  • 5 years experience in modern programming languages (Java, Python, JavaScript, etc.).
  • 5 years understanding of web services technologies such as REST, HTTPS, and JSON.
  • 5 years experience with general-purpose programming languages.
  • 5 years in defining system architectures and optimizing technical capabilities.
  • Preferred: 3 years in enterprise-scale ML solutions and deploying ML APIs.
  • Ability to collaborate effectively across teams and communicate technical concepts.

  • Understanding and translating business and functional needs into machine learning problem statements.
  • Translating complex machine learning problem statements into specific deliverables and requirements.
  • Designing and developing scalable solutions that leverage machine learning and deep learning models.
  • Translating machine learning algorithms into production-level code.
  • Collaborating with development teams to test and deploy machine learning models.
  • Monitoring the performance of deployed models and retraining as necessary.
  • Ensuring adherence to performance standards and data security requirements.

PythonSoftware DevelopmentAgileBusiness AnalysisDesign PatternsDjangoFlaskHTMLCSSJavaJavascriptMachine LearningSCRUMJiraProduct DevelopmentAlgorithmsAmazon Web ServicesData StructuresFastAPIGoAngularNosqlReactSoftware Engineering

Posted about 2 months ago
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