The Associate Architect assists in the design, development, and optimization of architecture strategies to meet business needs. They facilitate the development of enterprise solutions and provide strategic consultation to business customers regarding technology and process improvements.
The role involves reviewing and interpreting medical records to assign accurate ICD-10 and CPT codes for diagnoses and procedures. Additionally, the coder abstracts data for statistical reporting and acts as a subject matter expert to mentor other staff members.
The incumbent captures inbound inquiries for utilization management review and assesses requests by verifying benefit coverage. They are responsible for accurate data entry into the utilization management system and conducting follow-up communication with providers or pharmacists.
The Senior Case Manager is responsible for providing comprehensive case management services to members, including assessing needs, developing care plans, and coordinating services to ensure quality and cost-effective outcomes. They also act as a liaison between members and healthcare providers while providing mentorship to lower-level staff.
The Specialist Case Manager provides comprehensive case management services to members with complex needs to ensure quality, cost-effective care. They are responsible for developing individualized care plans, coordinating services, and monitoring member progress while ensuring compliance with regulatory standards.
The Senior Business Systems Analyst will collaborate with cross-functional teams to translate complex business needs into detailed requirements and drive quality solutions. They will also lead project teams, manage testing plans, and provide subject matter expertise throughout the software development life cycle.
The associate processes provider applications and re-applications while maintaining the provider database and coordinating credentialing verifications. They also manage credentialing inventory, generate reports, and support internal departments and external clients with complex credentialing issues.
The analyst provides operational support, maintenance, and troubleshooting for enterprise content management and information governance applications. They also assist with data migration, validation, and documentation to support system upgrades and information lifecycle management.
The SVP Clinical Guidance will lead the enterprise clinical strategy and the design of the Living Health Guidance System to shift from reactive administration to proactive clinical advocacy. This role involves overseeing the development of AI-driven clinical decision support tools and ensuring clinical intelligence is integrated across all member and provider touchpoints.
The Care Manager RN implements utilization management strategies, including reviewing health care service appropriateness and identifying opportunities for case management. They also monitor health care delivery, educate providers and members, and analyze data to improve performance and satisfaction.
The role involves designing, installing, and maintaining IMS databases within a z/OS Parallel Sysplex environment while ensuring high availability and performance. The incumbent will also lead database modeling, provide expert-level support for IMS issues, and collaborate with application teams to ensure seamless integration.
The incumbent performs business analysis tasks by supporting system applications, handling user inquiries, and driving quality business solutions. They participate in the full project life cycle, including requirements testing, defect management, and reporting to ensure system performance.
The Appeals Analyst reviews inquiries to determine if they meet the definition of a grievance or appeal and coordinates the resolution process with internal and external parties. They are also responsible for documenting investigation results and participating in workgroup meetings to address trends and process improvements.
The Community Health Worker acts as a liaison between members, providers, and community organizations to improve health outcomes and close care gaps. They conduct outreach, provide health education, and assist members in navigating the healthcare system and addressing social determinants of health.
The manager serves as the technical and strategic leader for the enterprise data protection program, overseeing data security, DLP, and encryption initiatives. They are responsible for managing a multidisciplinary team, establishing the security roadmap, and ensuring compliance with corporate and information security policies.
The Account Executive is responsible for driving sales revenue and growing market share by acquiring new clients within the national print and mail manufacturing footprint. They will manage the full sales cycle, including prospecting, needs assessments, contract negotiations, and ongoing client retention.
The Senior Investigator conducts investigations into potential fraud, waste, and abuse involving providers, members, and employees while managing anti-fraud programs. They also provide subject matter expertise, mentor team members, and coordinate with law enforcement and regulatory agencies to ensure compliance and financial recovery.
The Registered Nurse is responsible for assessing, planning, and implementing nursing care for patients in a home infusion setting. This includes administering infusion therapy, coordinating with interdisciplinary teams, and ensuring accurate documentation and patient education.
The Product Owner is responsible for managing the product backlog, translating business strategy into agile execution, and serving as the primary point of contact for cross-functional teams. They oversee product requirements, release planning, and stakeholder alignment to ensure the delivery of high-value business outcomes.
This role involves collecting, analyzing, and reporting on key performance indicators while developing dashboards and actionable insights. The analyst will collaborate with cross-functional teams to optimize data collection systems and ensure data quality and consistency.
The auditor will ensure claims are processed according to internal procedures and plan documents while monitoring audit workflows for timely turnaround. They will also provide coaching to the claims team, conduct specialized audits, and assist with system upgrade testing.
The pharmacist will work within a multi-disciplinary team to identify and close gaps in care for high-risk patients related to medication therapy. This involves conducting research, evaluating patient data, and intervening through direct communication with patients, caregivers, and healthcare providers.
The specialist coordinates and implements credentialing and privileging activities for medical and allied health staff. They are responsible for investigating practitioner backgrounds, verifying credentials against regulatory standards, and maintaining accurate documentation within the credentialing software system.
The Grants and Contracts Officer manages the pre-award process by facilitating grant proposals, budget preparation, and financial planning for research projects. They also act as a liaison between investigators and external organizations while ensuring compliance with legal and institutional policies.
The specialist will perform HCC coding for government programs, analyze medical documentation to ensure accurate risk adjustment, and support RADV audits. They will also mentor new hires and deliver training initiatives to improve coding accuracy and provider documentation.
The Transformation Manager leads mid-size engagements to drive organizational and operational improvements, including cost reduction and process optimization. They are responsible for managing project lifecycles, developing strategic solutions, and influencing stakeholders within a matrixed environment.
The Outreach Representative serves as a liaison between members and health plans, conducting telephonic support to assess needs and coordinate preventive health services. They also assist members in navigating grievance processes and track all interactions in internal systems for data collection.
The Product Manager will define and deliver data products leveraging conversational AI and omnichannel interaction data to improve member experience and operational efficiency. They are responsible for managing the product backlog, setting strategic roadmaps, and ensuring data governance and regulatory compliance.
The incumbent analyzes clinical data to identify trends and cost drivers while preparing reporting metrics for healthcare clients. They collaborate with internal teams to develop clinical management strategies and support the RFP/RFI process.
The lead is responsible for managing the Finance technology product roadmap and portfolio, ensuring alignment with strategic business objectives. They act as the primary liaison between Finance stakeholders and technology teams to oversee the end-to-end demand lifecycle and project delivery.
The HCC Coding Specialist performs accurate risk adjustment coding for Medicare Advantage, ACA, and ESRD programs to ensure compliance with CMS guidelines. They also collaborate with physicians and internal teams to support documentation improvement and participate in regulatory audits.
Lead the enterprise technology transformation of underwriting operating models and decisioning systems to create a scalable, data-driven ecosystem. Partner with cross-functional leadership to integrate advanced analytics and automation into underwriting workflows to drive measurable financial outcomes.
The senior coding auditor evaluates medical records to ensure the accuracy of coding, billing, and documentation for DRG and outpatient claims. They also develop educational programs to address audit findings and provide guidance to system entities regarding regulatory compliance.
The senior auditor leads complex clinical, documentation, and billing compliance reviews while providing guidance to the audit team. They are responsible for implementing orientation programs, conducting investigations, and managing corrective action plans to ensure adherence to federal and state regulations.
The Coding Coordinator assists management in overseeing coding and charging activities, including managing Epic work queues and communicating with vendors. They also serve as an Epic super-user, coordinating appeals and denials while ensuring timely billing through cross-departmental collaboration.
The incumbent manages post-award financial activities for grants, contracts, and clinical trials, including award set-up, compliance review, and financial reporting. They are responsible for analyzing financial results, ensuring accurate invoicing, and facilitating project close-out while adhering to institutional and sponsor policies.
The supervisor manages the Medicare Fee-for-Service appeals unit, delegating assignments and ensuring compliance with CMS thresholds and internal standards. They provide direct oversight to staff, handle high-profile provider situations, and monitor performance against budgetary and quality goals.
The Senior Case Manager is responsible for providing comprehensive case management services to members with complex health needs to ensure quality and cost-effective care. They will develop and implement individualized care plans while collaborating with physicians and healthcare providers to monitor member progress.
The Provider Relations Liaison is responsible for recruiting, training, and managing dental networks within an assigned territory to ensure contractual compliance and network growth. They act as the primary intermediary between the organization and dental providers, facilitating contract negotiations, financial performance monitoring, and quality improvement initiatives.
The Community Health Worker acts as a liaison between members and healthcare providers to improve health outcomes and close care gaps. They conduct face-to-face outreach, provide health literacy education, and assist members in navigating the healthcare system and accessing community resources.
The Senior Architect leads the design, development, and optimization of complex architecture strategies, specifically focusing on the Digital Chat Platform. They provide strategic consultation to business customers and mentor team members to ensure high-quality, scalable application development.
The Mainframe Storage Administrator will assist in researching, designing, and implementing mainframe infrastructure systems while ensuring compliance with organizational standards. They will also provide production monitoring, support, and collaborate with cross-functional teams to deliver technical solutions.
The consultant will partner with sales and marketing teams to drive the adoption of innovative health products and services for key accounts. They are responsible for managing a book of business, delivering client presentations, and developing account-specific marketing plans.
The Senior Program Manager is responsible for the definition, implementation, and delivery of complex, cross-functional programs within scope, quality, and budget constraints. They lead matrixed teams, manage technology roadmaps, and utilize change management methodologies to ensure security behavior engagement and risk mitigation.
The incumbent serves as the primary liaison between Highmark and the Blue Cross Blue Shield Association, managing operational compliance and strategic initiatives. They are responsible for negotiating Inter-Plan program policies, overseeing financial reimbursement structures, and providing expert testimony in legal matters related to national business operations.
This leadership role oversees underwriting operations, managing team performance and strategic initiatives to support customer acquisition and retention. The incumbent collaborates with sales leadership to develop book management strategies and ensures adherence to internal and governmental regulations.
The supervisor manages the Medicare Fee-for-Service appeals unit, delegating assignments and ensuring compliance with CMS thresholds and internal standards. They provide direct oversight to staff, handle high-profile provider issues, and monitor departmental performance against budget and quality goals.
The incumbent manages a book of business for existing accounts, acting as a strategic consultant to ensure retention and growth. Responsibilities include conducting service calls, managing senior-level relationships, and leading internal partners to deliver client strategy.
The incumbent will support, maintain, and optimize cloud technologies through engineering and automation builds. They will collaborate with cross-functional teams to design, test, and implement technical solutions that meet organizational goals.
The investigator is responsible for developing anti-fraud programs and conducting investigations into alleged fraud, waste, and abuse by providers and members. They must also prepare cases for legal referral, testify in court, and coordinate the recovery of misappropriated funds.
The dietitian directs and provides nutrition care to patients through assessment, planning, implementation, and monitoring. They also provide nutrition education to patients and staff while maintaining accurate documentation and reports.
The incumbent facilitates the implementation and administration of group accounts by managing stop loss sales cycle tasks and resolving issues related to underwriting and account service. They also act as a primary point of contact for producers and clients while coordinating new business and renewal activities.
The Payroll Administration Specialist is responsible for executing accurate multi-state payroll processing and maintaining HR information systems. They also provide Tier Two support for payroll-related inquiries and ensure compliance with federal, state, and local regulations.
The Identity & Access Management Security Engineer participates in the development, testing, implementation, and integration of IAM systems and solutions. This role focuses on supporting identity solutions, troubleshooting access issues, and ensuring the security of information resources.
The Senior Oracle Cloud EPM Analyst will administer, maintain, and enhance Oracle Cloud EPM applications, with a primary focus on Planning and EPBCS. They will also partner with Finance, Accounting, and IT teams to translate business requirements into scalable technical solutions and provide production support.
The consultant manages a block of stop loss business, overseeing new business and renewal pricing, risk analysis, and financial performance. They collaborate with sales, clinical, and underwriting teams to develop creative solutions and provide leadership and training to staff.
The specialist manages department activities to ensure compliance with regulatory guidelines such as NCQA, CMS, and DPW. They also oversee case management policies, conduct internal audits, and facilitate process improvements across the organization.
The Senior Business Systems Analyst supports the application product life cycle by translating business needs into detailed requirements and driving quality solutions. They lead project teams, manage cross-functional dependencies, and act as a subject matter expert to ensure successful delivery of business capabilities.
This role provides critical sales account support for the Stop Loss Business Unit, managing complex sales cycle tasks and facilitating account implementation. The incumbent acts as a primary point of contact for resolving issues related to RFP intake, underwriting, and ongoing group account service.
The Database Administrator will manage the day-to-day operations, maintenance, and performance tuning of cloud-based database systems. They are also responsible for implementing backup and recovery strategies, ensuring high availability, and collaborating with application teams on database design and troubleshooting.
The manager provides leadership oversight to a group of project managers, ensuring delivery processes are followed and obstacles are removed. They are responsible for staff development, budget management, and resolving cross-domain scheduling conflicts.
The Principal Information Security Architect leads the design and advancement of enterprise data security architectures to protect sensitive information across its lifecycle. They collaborate with cross-functional teams to establish secure solutions for modern data platforms, analytics environments, and cloud infrastructure.
The Lead Enterprise Architect will drive technology strategy and innovation by designing comprehensive architecture roadmaps and leading AI solution strategies. This role involves providing strategic consultation to business customers and mentoring team members to ensure cohesive, scalable, and cost-effective enterprise solutions.
Lead the full project lifecycle from concept to delivery for mid-to-large initiatives, ensuring they are completed on time and within budget. Manage resources, mitigate risks, and maintain strong communication with stakeholders through detailed reporting and documentation.
Lead the full project lifecycle for large to extra-large initiatives, ensuring delivery on time, within budget, and to quality standards. Manage resources, mitigate risks, and maintain strong communication with stakeholders through detailed reporting and documentation.
The role is responsible for the performance and capacity management of the IBM zEnterprise mainframe environment to ensure system efficiency and cost-effectiveness. Key duties include capacity forecasting, performance tuning of middleware, and cross-functional collaboration with DevOps teams.
The role involves designing and developing research databases and analytic solutions to address clinical and financial healthcare challenges. The informaticist serves as a liaison between physicians and research staff to translate data needs into actionable insights.
Drive change within Utilization Management and Medical Policy operations by bridging clinical decision-making and operational finance. Develop robust financial and operational data models to quantify the impact of medical policies and track administrative costs.
Conduct information risk assessments and formulate risk scoring to identify business threats and vulnerabilities. Partner with technical teams to integrate security architecture requirements and ensure compliance with standards like HITRUST and ISO 27001.
Manage Information Security and Risk Management services, overseeing personnel, budgets, and the implementation of security technology products. Lead strategic planning, ensure corporate policy compliance, and develop security awareness training programs.
Manage a team of clinicians to optimize member outcomes and ensure care is medically appropriate and cost-effective. Oversee department processes, ensure regulatory compliance with NCQA and CMS, and lead staff development and performance evaluations.
Develops and maintains clinical information systems and medication orders to ensure patient safety and operational efficiency. Collaborates with clinical and IT teams to design EMR solutions and manage interfaces with pharmacy applications.
The role involves analyzing industry data and financial conditions to assess risk for small and mid-sized clients. The underwriter collaborates with sales teams to deliver quotes and provide strategic risk management recommendations.
Develops and executes strategic business plans for contract categories and manages high-dollar bids and GPO operational activities. Builds strategic relationships with supplier partners and presents business cases to senior leadership.
Responsible for the retention, growth, and profitability of medium to large customer accounts through strategic renewal negotiations and contract management. The role involves collaborating with internal teams to deliver product solutions and managing client issues to resolution.
Partner with sales and marketing to drive the adoption of innovative healthcare products through consultative client advising and presentations. Manage a book of business and develop client-specific marketing plans for key accounts to meet their strategic needs.
The role focuses on driving the adoption of innovative health products through consultative selling and client presentations in partnership with sales and marketing. It involves managing a book of business, developing client-specific marketing plans, and serving as a product expert for implementation and problem resolution.
Drive the adoption of innovative health products by partnering with sales and marketing to deliver consultative client presentations. Manage a book of business and develop client-specific marketing plans to meet the needs of large key accounts.
Drive the adoption of innovative health products by partnering with sales and marketing to deliver consultative client presentations. Manage a book of business and develop client-specific marketing plans for key accounts to meet their specific needs.
The role focuses on driving the adoption of innovative health products through consultative selling and client presentations. It involves managing a book of business and developing client-specific marketing plans for key accounts.
The role focuses on creating data-driven insights and reporting solutions to improve healthcare costs, outcomes, and patient experiences. The analyst serves as a technical expert, leading the design and execution of clinical and population health analyses for internal and external stakeholders.
Lead the development and evolution of network products by defining the value proposition, vision, and multi-year strategy. Oversee the entire product lifecycle from ideation to optimization while collaborating with internal strategy and operations teams.
Lead the development of actuarial studies and analyses focusing on insurance pricing, claim trends, and profitability. Provide technical guidance to junior staff and represent the department's needs in cross-disciplinary settings.
Lead the design, implementation, and maintenance of critical mainframe systems including z/OS, DB2, and CICS. The role involves driving platform improvements, troubleshooting critical issues, and mentoring junior engineers in a geographically dispersed environment.
The role focuses on adopting, maintaining, and optimizing cloud technologies and automation builds across the organization. Responsibilities include designing and implementing technical solutions, collaborating with stakeholders, and mentoring junior engineers.
Lead the advancement and integration of the marketing technology stack and AI to scale marketing efforts. Manage vendor relationships, operational strategies, and the delivery of platform roadmaps in collaboration with IT and other stakeholders.
Perform thorough medical record reviews to abstract data and apply ICD and CPT codes for diagnoses and procedures. Manage unbilled coding reports to ensure efficient cash flow and maintain up-to-date knowledge of coding guidelines.
Lead the development of actuarial studies and analyses to inform management decisions across various insurance functions. Guide and mentor junior staff while implementing efficient processes for pricing, claim trends, and profitability analysis.
The role involves applying actuarial techniques and statistical analysis to functions such as pricing, claim trends, and profitability. The analyst is responsible for developing data queries, creating studies for decision-makers, and participating in the Actuarial Executive Development Program.
Lead a team of actuarial and analytics professionals to manage claims reserving, financial forecasting, and trend analytics. Provide strategic guidance to senior leadership to ensure financial stability and regulatory compliance across the enterprise.
Provides clinical consultation and utilization management reviews for behavioral health and addiction services within Medicaid and Medicare programs. Collaborates with leadership to develop strategic directions, ensure compliance with medical standards, and manage provider networks.
Perform financial and business research, including the preparation of forecasts, trend analysis, and financial reports. Lead special projects by gathering data, documenting findings, and presenting results to management to improve business outcomes.
The role focuses on the product management lifecycle for Provider Data Exchange, translating business needs into detailed requirements. It involves collaborating with stakeholders to manage product backlogs, roadmaps, and ensuring quality delivery through Agile methodologies.
The Manager of IT Data Governance provides operational leadership for the data governance team to support IT projects and enterprise data standards. They are responsible for managing data owners, facilitating governance councils, and ensuring continuous process improvement across the organization.
The Registered Nurse is responsible for assessing patient needs, planning and implementing nursing care, and administering infusion therapy in home settings. They must maintain accurate medical records, coordinate with interdisciplinary teams, and ensure adherence to safety and quality standards.
The Senior Cyber Incident Responder leads complex cyber investigations and coordinates incident response efforts within the Cyber Fusion Center. They are responsible for analyzing threat data, performing forensic collections, and providing expert technical guidance to ensure enterprise-wide security.
This role involves instructing, directing, and checking the work of other analysts and programmers while formulating complex system scope and objectives for assigned projects. Responsibilities include providing complex architecture and technical designs, managing the entire application life cycle, and ensuring adherence to project schedules.
The Imaging Institute is expanding services and locations, recruiting radiologists for musculoskeletal imaging roles. Positions are available as part-time or full-time, with options for onsite, hybrid, or remote work arrangements.
Physicians will provide a full range of diagnostic neuroradiology services across various AHN facilities, including trauma centers and stroke centers, utilizing state-of-the-art imaging technologies. Involvement in clinical and didactic teaching for residents and medical students, along with active participation in multidisciplinary conferences, is also expected.
The role involves reading chest imaging exclusively or a combination of chest and cardiac imaging, with options for body imaging interpretation available. Responsibilities include providing diagnostic services across plain film, various CT modalities (including cardiac CT), and MR imaging (including cardiac MRI).
The Registered Nurse assesses human responses and plans, implements, and evaluates nursing care for individuals or families, assuring safe delivery of nursing services in alternative care settings like home infusion visits to administer therapy. Responsibilities include active participation in interdisciplinary communication, directing ancillary care, accurate documentation, and timely implementation and evaluation of physician orders.
The Mainframe Systems Programmer will install, upgrade, and manage CICS/MQ environments, ensuring the health and stability of the mainframe system. They will also participate in disaster recovery exercises and troubleshoot issues to determine root causes.
This role involves identifying and cultivating prospects and clients for the profitable sale of core and supplemental HNAS products within an assigned region, directly or through intermediaries. The incumbent will lead new business meetings, close sales for groups generally spanning 1,000-10,000 members, and manage complex account needs.
The coder performs thorough medical record reviews to abstract medical and demographic data and applies appropriate ICD codes for diagnoses and procedures. They also ensure efficient management of medical information and assist in decreasing average accounts receivable days.
The Sales Executive actively prospects for new clients and manages relationships with existing accounts to ensure retention and growth. They are responsible for selling core and supplemental products while acting as a strategic consultant for clients.
The Medical Director ensures that utilization management responsibilities are performed according to clinical standards by reviewing escalated cases and determining medical necessity. They also participate in multidisciplinary teams for case and disease management, advising on high-risk cases and managing special projects.
