Perform business analysis to support specific system applications, handling user inquiries and driving quality business solutions. Responsibilities include capturing capability needs, maintaining project deliverables, and supporting requirements testing to minimize production defects.
Highmark Health
72 Remote Job Openings at Highmark Health
Execute audit activities related to IT security, system implementations, and data privacy to ensure risk management and governance processes are functioning. Develop recommendations for business process improvements and maintain high-quality audit work papers.
Provide strategic legal advice and support to discrete business units, ensuring compliance with federal and state laws. Manage litigation, transactions, and outside counsel while delivering business-oriented legal solutions.
Lead complex strategic initiatives to optimize healthcare programs through data-driven analysis and actionable recommendations. Act as an internal consultant to cross-functional stakeholders to drive program effectiveness and resource alignment.
Business Analyst - Sponsored Programs Financial Services - Clinical Trials
Highmark Health
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Full Time
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4 days ago
Highmark Health
Responsible for post-award financial management, including award set-up, transaction processing, and compliance review for grants and clinical trials. The role involves managing invoicing, month-end close processes, and preparing complex financial reports to facilitate business decisions.
Strategic Analytics Consultant - UM Transformation
Highmark Health
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Full Time
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4 days ago
Highmark Health
Lead complex strategic initiatives to optimize clinical programs and improve health outcomes through data-driven analysis. Translate analytical findings into actionable business cases and strategic recommendations for senior management.
Provides care planning, coordination, and follow-up for high-risk patients to prevent poor health outcomes. Acts as a liaison between patients, families, and various healthcare services while maintaining accurate documentation and supporting health behavior improvements.
Member Engagement Guide - Remote in Central PA.
Highmark Health
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Full Time
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5 days ago
Highmark Health
Develop member transition strategies to steer members toward AHN and community providers while educating them on insurance benefits and healthcare costs. Partner with sales teams to execute strategies that increase enrollment and profitability through influenced buying decisions.
Responsible for answering calls in a centralized call center to provide first-call resolution for patient inquiries. This includes processing complex medical service requests and referring patients to appropriate physicians or specialists.
Responsible for the definition, implementation, and delivery of complex corporate programs through cross-functional collaboration. Manages project teams, monitors financial health, and implements risk mitigation strategies to achieve business objectives.
Provides guidance to front-line staff and ensures efficient delivery of pharmacy call center services. Reviews medication exception requests and manages prior authorizations in adherence to state and federal drug benefit designs.
The role involves supporting the design, development, and maintenance of technical solutions across infrastructure, systems, and networks. Key duties include collaborating with stakeholders to gather requirements and documenting technical processes to ensure alignment with enterprise goals.
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.
Social Worker - ECCM - Palliative Care (Remote)
Highmark Health
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Full Time
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11 days ago
Highmark Health
Collaborates with interdisciplinary teams to assess, plan, and document psychosocial factors affecting patient care and continuity. Provides crisis intervention, counseling, and discharge planning to enhance coping mechanisms for patients and families.
Coordinate high-quality, cost-effective healthcare for members with complex medical and psychosocial needs through holistic assessment and care planning. Collaborate with providers and community resources to monitor outcomes and advocate for appropriate care plans.
Coordinate high-quality, cost-effective healthcare for members with complex medical and psychosocial needs through holistic assessment and care planning. Collaborate with providers and community resources to monitor outcomes and advocate for appropriate care plans.
Identity Access Management Security Engineer
Highmark Health
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Full Time
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11 days ago
Highmark Health
Develop, implement, and integrate Identity and Access Management (IAM) systems to protect information resources from unauthorized access. Monitor IAM systems, troubleshoot complex access issues, and provide training on IAM capabilities and standards.
The analyst bridges the gap between business needs and technical solutions by gathering requirements and creating process flows. They are responsible for extracting data, building reports, and configuring Salesforce to support data-driven decision-making.
The role supports Enterprise Transformation project teams by analyzing qualitative and quantitative data to shape strategic recommendations. Key duties include owning project deliverables, building reports, and facilitating design sessions for clients.
Senior Technical Engineer - Senior Cloud Engineer
Highmark Health
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Full Time
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14 days ago
Highmark Health
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.
Coordinates the enrollment and credentialing of professional providers with various payers to ensure reimbursement for services. Maintains accurate provider data, resolves enrollment issues, and manages tracking databases for executive reporting.
The RN Nurse Navigator serves as the primary point of contact for patients and providers to facilitate patient flow and coordinate comprehensive care within a specialized disease state. Responsibilities include managing community outreach, coordinating multidisciplinary appointments, and reducing hospital re-admissions through high-risk care team collaboration.
Healthcare .NET Senior Application Developer - HNAS
Highmark Health
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Full Time
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14 days ago
Highmark Health
Lead the analysis, design, coding, and implementation of complex application enhancements and provide general production support. Collaborate with business analysts and IT teams to deliver innovative technical solutions that adhere to company standards.
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.
The role is responsible for driving strategic activities across solution portfolios, including problem-solving, data analytics, and business model design. The incumbent will optimize end-to-end workflows and develop technical requirements to improve productivity and cost-effectiveness.
Manager Financial Planning and Cost Analysis
Highmark Health
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Full Time
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18 days ago
Highmark Health
Lead the financial narrative for enGen by managing the monthly close cycle, rolling forecasts, and executive reporting for the CFO and board. Oversee the finance team's daily operations, including staff development and the implementation of AI-driven automation and Power BI reporting.
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.
Medical Case Manager - PA, DE, WV (Remote)
Highmark Health
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Full Time
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22 days ago
Highmark Health
Provide comprehensive case management for members with complex medical and psychosocial needs across PA, DE, and WV. Coordinate care plans by collaborating with physicians, community resources, and interdisciplinary teams to ensure cost-effective, high-quality healthcare.
Acts as a liaison between members, health plans, and regulators to provide telephonic support and education on preventive health. Responsible for assisting members with the grievance and appeals process and enrolling them in Disease Management Programs.
Manage the full lifecycle of post-acute care contracts, focusing on home health, hospice, and skilled nursing facilities. Act as a critical intermediary between the organization and external providers to ensure financial reimbursement and contractual compliance.
Director, Product Management - Government Segment
Highmark Health
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Full Time
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a month ago
Highmark Health
Lead product management for the Acquisition & Onboarding portfolio within the Government segment, focusing on Medicare and ACA membership growth. Define product visions, execute multi-year roadmaps, and manage the full product lifecycle from ideation to launch.
Medical Director - Behavioral Health (Medicaid)
Highmark Health
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Full Time
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a month ago
Highmark Health
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.
The incumbent manages a panel of members by assessing health needs and implementing appropriate clinical interventions and care plans. They coordinate multi-disciplinary resources and monitor quality outcomes to help members achieve personal health goals.
Lead information risk assessments to identify business risks and drive the adoption of security policies, standards, and controls. Partner with architecture teams to integrate security into solution designs and ensure compliance with standards like HITRUST and ISO 27001.
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 Medical Director performs utilization management reviews to evaluate the medical necessity and appropriateness of treatments based on clinical standards. They also serve as the physician expert within a multidisciplinary team for case and disease management.
Epic Systems Analyst– Resolute Hospital Billing & Claims
Highmark Health
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Full Time
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2 months ago
Highmark Health
Responsible for configuring, implementing, and supporting the Epic Resolute Hospital Billing and Claims application. This includes performing workflow analysis, resolving system issues, and providing guidance to end-users.
Provide high-volume customer service to subscribers and providers while processing and adjusting insurance claims. Research eligibility, handle COB investigations, and resolve inquiries via phone, email, and chat.
Lead the strategic vision and execution of payer/provider interoperability products to improve health outcomes and reduce administrative burden. Manage the product roadmap, backlog, and cross-functional delivery while mentoring junior product team members.
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.
Analyzes medical risk factors for new and renewing insurance contracts to determine appropriate enrollment and rating decisions. Prepares clinical record reviews for appeals and provides predictive reporting on high-cost medical claimants.
The incumbent will provide consultative leadership to design, configure, and deploy HCM and payroll solutions while managing stakeholder expectations and project timelines. They are responsible for identifying system improvement opportunities, developing requirements, and ensuring high customer satisfaction through effective communication and process design.
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.
Associate Technical Analyst - Pathology Systems Administrator
Highmark Health
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Full Time
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2 months ago
Highmark Health
The Pathology Systems Administrator manages the daily administration, support, and lifecycle of enterprise pathology and laboratory information systems. This role collaborates with clinical stakeholders and IT teams to ensure system reliability, regulatory compliance, and effective diagnostic workflows.
Advanced Practice Provider - Pittsburgh, PA
Highmark Health
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Full Time
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2 months ago
Highmark Health
Conduct comprehensive in-home, virtual, and telephonic clinical assessments for patients with chronic health conditions. Manage palliative care, facilitate advance care planning, and coordinate with interdisciplinary teams to ensure optimal health outcomes.
The incumbent manages a panel of members by assessing health needs, developing care plans, and coordinating clinical interventions to improve health outcomes. They also monitor quality metrics and ensure all activities comply with regulatory standards and accreditation requirements.
This role involves the design, build, implementation, and support of Epic Willow Ambulatory applications for retail and outpatient pharmacy operations. The analyst will partner with pharmacy leadership and IT teams to optimize medication workflows, ensure system stability, and manage retail pharmacy integrations.
The DevOps Manager will lead the DevOps function, overseeing a team of engineers to drive infrastructure evolution, automation, and reliable product delivery. This role involves strategic roadmap execution, cross-functional collaboration, and ensuring system reliability, security, and compliance.
RN Registered Nurse (part-time) - AHN Home Infusion - Pittsburgh and Surrounding Areas (territory-based travel)
Highmark Health
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Full Time
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2 months ago
Highmark Health
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.
Complex Case Manager RN - Specialty Pediatrics (Remote)
Highmark Health
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Full Time
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3 months ago
Highmark Health
The incumbent manages a panel of members by assessing health needs, developing individualized care plans, and coordinating clinical interventions. They monitor patient outcomes and ensure all activities comply with regulatory standards and organizational policies.
Clinical Transformation Consultant - Central PA/Lehigh Valley
Highmark Health
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Full Time
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3 months ago
Highmark Health
The consultant leads provider practice transformation initiatives to improve clinical operations and patient outcomes across various healthcare settings. They facilitate change through baseline analysis, gap assessments, and the implementation of evidence-based best practices.
The analyst reviews, evaluates, and processes complex Stop Loss claims while ensuring compliance with policy provisions and regulatory guidelines. They also provide client counseling, monitor claim losses, and assist leadership in evaluating client performance and system efficiency.
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.
Imaging Institute - Musculoskeletal Radiologist - Remote, Evening
Highmark Health
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Full Time
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3 months ago
Highmark Health
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.
Imaging Institute - Cardiothoracic Physician - Remote
Highmark Health
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Full Time
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3 months ago
Highmark Health
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).
Imaging Institute - Neuroradiologist - Remote
Highmark Health
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Full Time
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3 months ago
Highmark Health
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.
Infusion RN Registered Nurse - AHN Pediatric Home Infusion - Pittsburgh and Surrounding Areas (TRAVEL)
Highmark Health
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4 months ago
Highmark Health
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.
This role involves configuring, deploying, and supporting assigned Epic application(s), including performing business/systems analysis, defining requirements, designing systems, and resolving problems for end-users. The analyst will plan, build, test, implement, and maintain Epic software environments to meet user needs and manage small to medium projects independently.
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.
Associate Technical Engineer - Biomedical Device Integration
Highmark Health
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Full Time
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5 months ago
Highmark Health
The Analyst is responsible for planning, implementing, and supporting medical device integration solutions across the provider network, acting as a technical expert to ensure seamless data exchange between medical devices and EHR systems. Key duties include analyzing, designing, coding, testing, and implementing technical solutions while collaborating with clinicians, IT staff, and vendors to optimize workflows.
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.
Account Executive II - United Concordia Dental
Highmark Health
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Full Time
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5 months ago
Highmark Health
The Account Executive II is responsible for the retention, growth, and profitability of an assigned customer base, focusing on medium, large, and key accounts. This includes negotiating financial renewals, managing client issues, and implementing business strategies.
The Senior Marketing Analytics Analyst transforms customer and campaign data into insights to improve marketing effectiveness. This role involves developing digital strategies, building performance dashboards, and evaluating campaign ROI.
Principal Data Architect: Data Movement, Enrichment, and Orchestration
Highmark Health
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Full Time
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6 months ago
Highmark Health
Lead the development and articulation of complex architecture vision and strategy, ensuring alignment with business goals. Champion the adoption of best practices and emerging technologies while collaborating with senior stakeholders across the organization.
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 Epic Systems Analyst is responsible for configuring, rolling out, and supporting the Epic Orders application. This includes analyzing system requirements, performing workflow analysis, and providing guidance to end-users.
Part-Time Weekend Medical Director (Remote)
Highmark Health
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Full Time
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8 months ago
Highmark Health
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.
