The pharmacist will perform extensive literature reviews to develop clinical criteria for pharmacy benefit management and conduct medical necessity reviews for prior authorizations. They will also serve as a formulary expert and liaison between the health plan and its customers.
Geisinger
68 Remote Job Openings at Geisinger
Underwriter Lead, Geisinger Health Plan (Pennsylvania resident)
Geisinger
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Full Time
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4 hours ago
Geisinger
Provides leadership and technical guidance to underwriters regarding rating decisions, model updates, and financial forecasting. Analyzes claims experience and competitor data to develop underwriting guidelines and premium rating strategies for group risk.
The Staff Scientist will develop, execute, and analyze behavioral science projects and 'nudges' to improve healthcare outcomes. Responsibilities include leading research projects, authoring scientific publications, and collaborating with internal and external stakeholders.
Pharmacy Service Representative Associate, Geisinger Health Plan (Eastern Standard Time Zone resident)
Geisinger
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Full Time
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6 hours ago
Geisinger
Assists leadership in processing provider and member prior authorization requests for pharmacy benefits. Collaborates with pharmacists to resolve clinical issues and documents all inquiries according to departmental policy.
Improvement Optimization Advisor Associate (Pennsylvania resident)
Geisinger
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Full Time
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2 days ago
Geisinger
Facilitates multidisciplinary teams to drive operational and clinical process improvements through data analysis and project management. Focuses on enhancing patient experience, safety, and efficiency within a single system platform.
Customer Care Associate - Medicaid Team, Geisinger Health Plan (must reside in Eastern Standard Time Zone)
Geisinger
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Full Time
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3 days ago
Geisinger
Serve as the primary point of contact for health plan customers to resolve concerns regarding benefits, eligibility, and claims. Coordinate with internal departments to provide accurate information and document all customer inquiries and grievances.
Design, develop, and maintain scalable automation solutions using UiPath and other tools within the Intelligent Automation Hub. Collaborate with stakeholders to analyze business requirements and provide technical leadership through code reviews and mentoring.
Health Insurance Sales Representative, Licensed - Geisinger Health Plan (Pennsylvania resident in Geisinger service area*)
Geisinger
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Full Time
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3 days ago
Geisinger
Cultivate new sales of Medicare Advantage and supplemental plans through group and home presentations. Build collaborative relationships with community-based organizations and strategic partners to develop prospects in the assigned region.
Financial Improvement Advisor Intermediate (Eastern United States resident)
Geisinger
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Full Time
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4 days ago
Geisinger
Provide operational financial support and leadership for performance improvement initiatives and business cases. Collaborate with project management and finance teams to ensure goal achievement and compliance with financial standards.
Provides project management and administrative support for market advancement and growth initiatives. Responsibilities include maintaining databases, coordinating due diligence materials, and facilitating communication between strategy and marketing teams.
Lead the end-to-end transformation of the enterprise contracting process and Contract Lifecycle Management (CLM) capabilities across the organization. Manage a team of specialists to drive compliance, operational efficiency, and the integration of CLM into business decision-making.
Directs an IT team to support organizational segments and develops technology strategies in collaboration with leadership. Oversees project implementation, vendor management, and budget administration while mentoring staff.
Acts as the subject matter expert for disability and accommodation management across the enterprise. Responsible for managing the interactive process under the ADA and developing return-to-work programs.
Customer Financial Specialist Associate (work from home eastern United States resident)
Geisinger
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Full Time
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7 days ago
Geisinger
Handle inbound and outbound calls in a call center setting to assist patients with billing and financial inquiries. Manage accounts receivable functions, including cash collection, installment plans, and financial assistance programs.
Provides outreach and navigation assistance to patients with complex medical and social needs within the community. Collaborates with multidisciplinary teams to implement care plans, conduct home safety evaluations, and ensure medication adherence.
Develop and implement scalable on-demand training programs and online tracking systems. Collaborate with subject matter experts to design courses using instructional theory and media applications.
Responsible for developing and producing member communications, including newsletters, web content, and social media campaigns. Manages the end-to-end production process from writing and layout to vendor coordination and distribution.
Manages the enrollment process for providers and facilities with third-party payers, including Medicare and Medicaid. Ensures compliance with regulatory changes and maintains provider data within billing systems like Epic.
Responsible for the implementation, enhancement, and support of EHR systems, specifically focusing on Epic Bridges interfaces. This includes gathering workflow requirements, performing system builds, and providing 24/7 on-call technical support.
Identify and implement supply chain expense opportunities to optimize organizational spending through strategic sourcing and formulary management. Manage the full procurement lifecycle, including competitive bidding, contract negotiation, and post-execution compliance monitoring.
The intern supports pharmacists by performing technical pharmacy operations and providing care to patients, providers, and customers. Duties include preparing and labeling medications, managing inventory, and maintaining pharmacy records.
Service Line Specialist Revenue Management (Pennsylvania resident)
Geisinger
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Full Time
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18 days ago
Geisinger
Manage professional and hospital billing and collection functions to ensure efficient cash flow and revenue enhancement. This includes adjudicating claims, resolving credit balances, and analyzing trends to improve organizational profitability.
Provides strategic and operational leadership for reimbursement and patient service revenue recognition to ensure regulatory compliance. Oversees financial estimates, third-party cost reports, and interactions with Medicare Administrative Contractors to optimize financial outcomes.
Geisinger Neuroradiology | $150K Starting Bonus | 7-on / 14-off Overnight Schedule | 100% Remote
Geisinger
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Full Time
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19 days ago
Geisinger
Perform remote neuroradiology interpretations for adult and pediatric patients, focusing on brain, head, neck, and spine imaging. Utilize advanced imaging tools and collaborate with a dedicated 3D radiology lab to process cases.
Service Line Specialist Revenue Management (Eastern Standard Time Zone resident)
Geisinger
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Full Time
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19 days ago
Geisinger
Manage billing, collection, and adjudication functions for clinical service lines to ensure efficient cash flow and revenue enhancement. This includes resolving accounts receivable issues, processing claims, and implementing quality initiatives within the revenue cycle.
Provide strategic and operational financial support for Geisinger Health business units, including forecasting, long-range financial modeling, and monthly operating reviews. Lead financial performance improvement initiatives and mentor other Finance Partners to develop a high-performing team.
Emergency Radiologist – $150K Starting Bonus | 100% Remote Nights | 7-On/14-Off
Geisinger
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Full Time
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25 days ago
Geisinger
Interpret a full range of imaging modalities, including Body and Neuro, for Level I and II trauma centers. Provide overnight coverage on a 7-on/14-off schedule working independently with subspecialty support.
Pharmacy Service Representative Associate, Geisinger Health Plan (Pennsylvania resident)
Geisinger
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Full Time
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a month ago
Geisinger
Assists Pharmacy Customer Service leadership in processing prior authorization requests for providers and members. Collaborates with pharmacists to resolve clinical issues and ensures adherence to pharmacy benefit policies and regulatory standards.
Appeals Coordinator, Geisinger Health Plan (Pennsylvania resident)
Geisinger
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Full Time
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a month ago
Geisinger
Administers the appeals and grievance process by serving as a liaison between members and the health plan. Investigates denied claims and services while ensuring compliance with regulatory timeframes and guidelines.
Appeals Coordinator, Geisinger Health Plan (eastern standard time zone resident)
Geisinger
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Full Time
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a month ago
Geisinger
Administers the appeals and grievance process by acting as a liaison between members and the health plan. Ensures all regulatory timeframes and documentation standards are met according to federal and state guidelines.
The Director serves as the enterprise strategy lead for a business unit, translating high-level direction into actionable multi-year plans and metrics. They partner with executive leadership to shape strategic choices and ensure alignment with enterprise priorities and governance.
The Director serves as the enterprise strategy lead for a business unit, translating high-level enterprise direction into actionable multi-year plans. They are responsible for shaping strategic choices, managing investment theses, and ensuring alignment between business unit execution and enterprise priorities.
Provides outreach and navigation assistance to patients with complex medical and social needs within the community. Collaborates with multidisciplinary teams to implement care plans, conduct medication reviews, and facilitate telemedicine visits.
Provides outreach and navigation assistance to patients with complex medical and social needs within the community. Collaborates with multidisciplinary teams to implement care plans, conduct medication reviews, and facilitate telemedicine visits.
Provides outreach and navigation assistance to patients with complex medical and social needs within the community. Collaborates with multidisciplinary teams to implement care plans, conduct medication reviews, and facilitate telemedicine visits.
RN - Registered Nurse - Clinical Documentation Improvement Educator
Geisinger
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Full Time
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a month ago
Geisinger
Develop and implement clinical documentation education programs and onboarding for CDI specialists and providers. Monitor medical records for accuracy in patient acuity and severity of illness while providing feedback to ensure compliant practices.
Customer Financial Specialist Associate (Eastern United States resident)
Geisinger
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Full Time
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a month ago
Geisinger
Handle inbound and outbound calls in a call center environment to assist patients with billing and financial inquiries. Manage accounts receivable functions, including cash collection, installment plans, and financial assistance programs.
Responsible for abstracting complex clinical data from electronic medical records into the cancer registry to support patient care and regulatory requirements. This includes case-finding, coding disease stages using TNM systems, and submitting data to state and national registries.
Financial Intelligence Analyst Lead (Eastern United States resident)
Geisinger
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Full Time
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a month ago
Geisinger
Lead the advancement of financial performance through reporting, analytics, and strategic service planning for Geisinger Health. Mentor a team of analysts while collaborating with operational leaders to drive cost reduction and financial improvement initiatives.
Project Manager Senior, Geisinger Health Plan (East Coast resident / EST)
Geisinger
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Full Time
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a month ago
Geisinger
Manages complex projects from inception to conclusion, specifically focusing on Pennsylvania DHS HealthChoices procurements. Acts as the primary coordinator between internal stakeholders and external consultants to lead proposal development teams.
Leads project teams to achieve goals on time and within budget by managing scope, timelines, and stakeholders. Responsible for risk management, budget tracking, and coordinating with IT functional leadership.
Collaborate on the design of clinical research studies and write biostatistical analysis plans for proposals and grants. Manage, analyze, and interpret study data while educating research team members on statistical methods.
Lead the full lifecycle of data science projects to develop AI models that predict acute healthcare utilization and improve population health outcomes. Collaborate with clinical leaders to translate complex data into actionable care pathways and mentor junior data scientists.
Leads the enterprise intelligence and strategy execution backbone by integrating strategic insights and performance management to inform decision-making. Oversees market assessments, consumer research, and the design of the enterprise strategic performance management system.
Program Director Information Technology (Epic Bridges)
Geisinger
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Full Time
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a month ago
Geisinger
Provides leadership and technical oversight for an assigned IT segment, focusing on policy creation and system reliability. Manages vendor contracts, departmental budgets, and operational KPIs to ensure efficient service delivery.
The Intermediate BI Developer converts complex data into intuitive dashboards and reports to enable data-driven decision-making. They consult with stakeholders to gather requirements and design reporting solutions for small to medium-sized projects.
Coordinates patient appointment scheduling and registration while ensuring adherence to physician-specific guidelines. Facilitates multi-channel communication between patients, providers, and internal departments to manage referrals and care gaps.
The Senior Contract Manager oversees the development, negotiation, and maintenance of complex contracts while ensuring compliance with regulatory standards. They also lead and coach a team of contract professionals and drive operational improvements in the contract lifecycle process.
The Associate BI Developer creates reports and dashboards to enable data-driven decision-making for the organization. They collaborate with internal partners to design reporting solutions and troubleshoot data quality issues.
Licensed Clinical Social Worker (Virtual) - Outpatient Adult
Geisinger
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Full Time
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2 months ago
Geisinger
The role involves assessing patient needs to develop treatment plans and providing individual, family, couple, and group psychotherapy. The practitioner will collaborate with psychiatry teams to provide triage evaluations and crisis intervention for adult outpatient patients.
Licensed Professional Counselor (Virtual) - Outpatient Adult
Geisinger
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Full Time
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2 months ago
Geisinger
The role involves assessing patient needs and developing treatment plans to improve functioning and symptom resolution. Responsibilities include providing individual, family, couple, and group psychotherapy while collaborating with psychiatry teams for crisis intervention.
Leads and mentors a team of data scientists and analysts to deliver high-quality AI/ML solutions for healthcare applications. Balances team management and strategic resource allocation with active technical development, spending approximately 50% of the time coding.
Business Intelligence Analyst Senior (AI Evaluation & Monitoring)
Geisinger
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Full Time
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2 months ago
Geisinger
The Senior BI Analyst partners with AI Evaluation & Monitoring teams to collect, clean, and interpret data sets to support data-driven decisions. They are responsible for running validation studies, instrumenting production monitoring, and translating complex analyses into actionable insights for non-technical stakeholders.
Business Intelligence Analyst Senior (AI Evaluation & Monitoring)
Geisinger
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Full Time
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2 months ago
Geisinger
The Senior BI Analyst partners with AI Evaluation & Monitoring teams to collect, clean, and interpret data to drive data-driven decisions. They are responsible for executing validation studies, monitoring production AI performance, and mentoring junior developers.
The Tech Lead Data Scientist will define and oversee the technical methodology for evaluating, monitoring, and optimizing AI systems in production. They will provide hands-on guidance to program teams and mentor a team of data analysts to ensure rigorous validation and performance measurement.
The Senior Data Scientist leads the end-to-end lifecycle of AI and machine learning initiatives to improve healthcare outcomes and operational efficiency. They also mentor junior staff and translate complex technical findings into actionable insights for stakeholders.
The Strategic Sourcing Specialist III identifies and implements supply chain expense opportunities to optimize organizational costs. They collaborate with clinical and operational leadership to manage product selection, standardization, and vendor contract negotiations.
Define and drive the product vision and roadmap for a portfolio of clinical and operational AI initiatives. Collaborate with cross-functional teams including data scientists, clinicians, and operational leaders to take AI solutions from discovery through deployment and scale.
The AI Data Scientist Team Lead architects end-to-end AI solutions and manages the AI Platform team, balancing technical solution design with engineering leadership. Responsibilities include defining the platform roadmap, mentoring engineers, and ensuring AI systems meet healthcare security and governance standards.
The Senior Platform Data Engineer owns the architecture, roadmap, and platform standards for clinical data products and AI infrastructure. They are responsible for building and maintaining real-time data feeds, RAG retrieval pipelines, and managing the Databricks environment to support AI at scale.
The analyst will build quantitative business cases and size AI opportunities to inform strategic investment decisions across clinical, operational, and health plan functions. They will design measurement frameworks for pilots and produce analytical narratives to guide organizational leadership.
The analyst will partner with product managers to quantify AI opportunities, define success metrics, and build measurement frameworks for AI performance in production. They will also conduct exploratory data analysis and ensure data quality across enterprise systems like Epic to inform strategic AI investment decisions.
Facilitate cross-functional AI product squads by managing planning, reviews, and retrospectives to ensure consistent delivery. Coach team members on agile principles and proactively resolve blockers to maintain project momentum.
Wellness Associate II (Pennsylvania - Lackawanna / Luzerne Counties)
Geisinger
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Full Time
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3 months ago
Geisinger
The Wellness Associate II is responsible for developing, implementing, and overseeing health and wellness programs for community and facility-based populations. They also provide on-site screening support, health coaching, and data reporting to ensure program effectiveness and stakeholder engagement.
This role provides strategic and operational leadership for nursing informatics, reporting to the CNIO, and is responsible for ensuring alignment between nursing practice, digital health strategy, and enterprise priorities. The director will lead, support, and develop the Nursing Informatics team within IT while serving as a key liaison to optimize the EHR and clinical workflows.
Patient Contact Specialist Bilingual (English / Spanish)
Geisinger
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Full Time
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9 months ago
Geisinger
The Patient Contact Specialist schedules medical appointments for patients, ensuring alignment with their preferences and physician guidelines. They also handle non-scheduling inquiries and maintain accurate patient information related to registration and insurance.
The Care Connector serves as the primary contact for the Special Needs Unit, assisting in resolving patient/member concerns and providing education and support. They manage crisis situations and advocate for patients/members who are unable to communicate effectively with service delivery systems.
RN - Registered Nurse Navigator Triage - Population Health
Geisinger
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Full Time
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9 months ago
Geisinger
The RN Nurse Navigator Triage provides nursing triage services and health advice for patients over the phone and in person. Responsibilities include assessing patients' acuity levels, providing education related to diagnostic testing, and coordinating care across departments.
