Job ID: J115703
Company: Highmark Inc
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: Jan 20, 2018
This job directs the development, implementation, oversight and continuous improvement of the systems, processes, policies and staffing necessary to ensure cost effective and consistent management of high cost members and high cost claims. This includes leading a multi-disciplinary team comprised of disease managers, case managers, utilization management, and analytics employees either through direct or indirect reporting relationships assigned to this specific segment of the Organization's members. Through a matrix reporting relationship to the High Cost Center of Excellence, the incumbent will ensure attainment of client and/or market-specific operational, clinical and financial commitments that help drive process improvement efforts to better manage and/or design member intervention programs and improve client/account expectations. Participates as a key driver of the development and execution of corporate strategies for the effective delivery of proactive, innovative and engaging health coaching and case management services. Uses internal analyses and external benchmarking to remain market-competitive and to continuously enhance the services being offered to both group clients and individual members. The incumbent will place specific focus on helping members through the continuum of care in a high quality, effective and cost efficient manner while tracking and being responsible for outcomes.
Bachelor's Degree in Nursing
Master's Degree in Nursing
Including any of the following
0% - 25%
Teaches / trains others regularly
Travel regularly from the office to various work sites or from site-to-site
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
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