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Highmark Jobs in West Virginia

31 Jobs Found

The Nurse Health Coach (HC) is the primary clinician providing condition and case management services to members with health-related conditions or serious medical issues. The HC uses clinical and motivational interviewing skills to assess members' n......
General Overview This job is the primary liaison between large/complex provider groups in the Highmark network and the corporation. Will be responsible for cultivating relationships with large/complex provider groups to gain buy in and "sell" stra......
Job Summary: The Underwriting Coordinator provides assistance as required by the underwriting unit to support renewal and new business activities. Gathers and organizes information and reports (e.g., loss runs, risk assessments, and loss ratings)......
General Overview: Manages activities of various IT personnel. Makes decisions on personnel actions (promotions, hiring, terminations, etc.) Develops talent, Addresses resource management, cultivates capabilities of staff, planning and coordinatio......
General Overview: Play a crucial role in the corporation's success and works closely with all divisions and departments within the corporate structure to provide clinical consultation and support with regard to program development, compliance wit......
General Overview: 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, qual......
General Overview: Physician who provides clinical support to the Medical Management & Policy team to ensure that utilization management activities are performed in accordance with the highest and most current clinical standards. Responsible to re......
General Overview: Manages activities of various IT personnel. Makes decisions on personnel actions (promotions, hiring, terminations, etc.) Develops talent, Addresses resource management, cultivates capabilities of staff, planning and coordinatio......
General Overview: Manages activities of various IT personnel. Makes decisions on personnel actions (promotions, hiring, terminations, etc.) Develops talent, Addresses resource management, cultivates capabilities of staff, planning and coordinatio......
General Overview Work closely with Sales, group customers, vendors, consultants, plan partners and others to administer processes and systems that generate claims data feeds to external entities. Work closely with customers, vendors and others to......
General Overview: Provide visibility to executive leadership that operations work inventory and performance is managed across all operational tiers to achieve the highest performance at the lowest cost. Monitor inventory levels and processing cap......
General Overview Direct all phases of product- related strategic and non-strategic projects, product development and distribution within the assigned product line. Provide oversight on several interrelated products on the total process/design fro......
General Overview Direct all phases of product- related strategic and non-strategic projects, product development and distribution within the assigned product line. Provide oversight on several interrelated products on the total process/design fro......
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The Nurse Health Coach (HC) is the primary clinician providing condition and case management services to members with health-related conditions or serious medical issues. The HC uses clinical and motivational interviewing skills to assess members' needs and establish mutually agreeable short and longer term goals. The HC supports members in developing self-management skills and adopting positive b...
General Overview This job is the primary liaison between large/complex provider groups in the Highmark network and the corporation. Will be responsible for cultivating relationships with large/complex provider groups to gain buy in and "sell" strategic initiatives for the purposes of piloting and implementing alternative care/reimbursement models. This job will maintain visibility in the provider...
General Overview: As one of the largest health insurers in the nation, we help millions of individuals everyday have access to the health insurance, care and other related services that they need to live longer, healthier lives. The customer service team handles customer inquiries by telephone and/or email and/or in person from individual members, groups, providers and brokers in a customer servic...
Job Summary: The Underwriting Coordinator provides assistance as required by the underwriting unit to support renewal and new business activities. Gathers and organizes information and reports (e.g., loss runs, risk assessments, and loss ratings) that support the underwriting decision. May assist the Underwriter with the computation of rates and premiums. May review incoming insurance applications...
General Overview This job is directly responsible for the value creation, impact and cost control and fiscal/ROI targets as set by the Organization, including revenue stream outcomes, and engagement of primary care providers (PCP) enrolled in government value based reimbursement programs and continuous improvement models. This job is a highly skilled subject matter expert (SME) in Medicare STARS,...
General Overview: As one of the largest health insurers in the nation, we help millions of individuals everyday have access to the health insurance, care and other related services that they need to live longer, healthier lives. The customer service team handles customer inquiries by telephone and/or email and/or in person from individual members, groups, providers and brokers in a customer servic...