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EEO is The LawEqual Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ()We endeavor to make this site accessible to any and all users. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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Develop and maintain moderate- to extremely-complex computer programs using 4GL programming languages (such as SAS, R, SQL) and other database technology (DB2, Teradata, and Oracle). Ability to use report generation products such as Power BIAbility to develop programs using SQL, SAS and ETL tools like Alteryx or DataikuStrong communication skills.
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Description : GENERAL OVERVIEW:Completes one or more of the following processes (scheduling, pre-registration, financial clearance, authorization and referral validation and pre-serviceability estimations and collections) within Patient Access and creates the first impression of AHN's services to patients and families and other external customers.
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5 years of understanding of web services technologies such as REST, HTTPS, JSON5 years with one or more general purpose programming languages including but not limited to: Java, Python (Django/Flask), C/C.
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3 years of experience working in mainframe development platform and have a good understanding of Cobol , JCL, DB2 CICS programs. The ideal candidate will have a solid background in software engineering, build and deploy automation, mainframe development basics, scripting knowledge and be familiar with the tools utilized in the DevOps workflow.
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Behavioral health conditions include serious mental illness, untreated mental health, alcohol use, and opioid use. The overall goal is to help members navigate the health care system and develop condition self-management skills through behavior changeESSENTIAL RESPONSIBILITIESFunction as a primary contact for members with Opioid Use Disorder (OUD)/Behavioral Health with co-morbid medical conditions including pregnancy to provide intensive case management interventions.
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Description : JOB SUMMARYThis job provides telephonic integrated behavioral and physical health case and condition management services to members with mental health, substance use, and co-morbid chronic medical conditions.
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The incumbent acts as a strategic business partner, interfacing at the VP and Director levels of the company, providing leadership in the designated spend category for category strategy/plans, strategic sourcing and other strategic procurement processes such as supplier relationship management, spend performance management, demand and compliance management, internal spend and external market analysis, and category governance.
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Support other internal initiatives which may include but not limited to fraud detection, corporate compliance, wellness/disease management, and product development efforts. Analyzes risk factors for new enrollment, annual renewals, and amendments of group insurance contracts or of self-funded plans in conformance with established underwriting policies, practices, and standards.
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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, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law.
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Maintain current knowledge and adheres to applicable CMS, state, local, and regulatory agency requirements and applicable standards of practice for case management including those published by CMSA and/or ACMA, as required by the organization.
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Description : JOB SUMMARY This job has primary ownership and oversight over a specified panel of oncology members that range in health status/severity and clinical needs. The incumbent assesses health management needs of the assigned member panel and utilizing data/analytics in conjunction with professional clinical judgement to identify the right clinical intervention for each member.
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Strong Technical Data Skills (SAS / SQL, R, Tableau, Excel, etc.) Proficiency to extract, summarize and analyze large datasets via SAS, SQL or other similar tools. This key new role will serve as the key link between the Finance/Consultative work in support of these initiatives and each business segment and functional area partners' work, with focus on 1) the analysis development to size the ideation, emerging results and financial impact 2) infrastructure and process development to link medical economic related analytics (trend reporting, medical cost, conditions, etc.
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In addition to identifying the appropriate clinical interventions and referrals, the incumbent will manage an active case load of members in his/her panel that are enrolled in case management. The incumbent is responsible for assisting members who have been newly diagnosed with Cancer and/or need assistance with a complex Oncology treatment plan and coordination of care.
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Provides guidance and support to end-users to enhance the use of Epic, and offers solutions to resolve end-user system issues. Responsibilities include business/systems analysis, requirements definition and documentation, system design, and problem resolution.
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women job Company: Highmark Health
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