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Highmark Health
Full time
 
Pharmacist - Utilization Management (UM) Remote
Highmark Health Pittsburgh, PA, USA
Company : Highmark Inc. Job Description : JOB SUMMARY This job reviews requests for medication coverage determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical information provided by the physician against medical policy criteria. The incumbent then uses his/her clinical knowledge compared to the policy and physician request to make a determination. At times, the incumbent may conduct additional research beyond medical policy review to make coverage determinations. ESSENTIAL RESPONSIBILITIES Make coverage determinations by evaluating physician requests for prior authorization or appeals against medical policy through the Utilization Review system. Update the system records appropriately to ensure claims are properly routed and paid. Conduct research beyond medical policy review to make decisions on medication coverage requests. Other duties as assigned. EDUCATION...

Jan 01, 2026
TIAA
Wealth Management Advisor-Philadelphia, PA
TIAA Philadelphia, PA, USA
Wealth Management Advisor Supported with a robust array of resources and solutions, Advisors at TIAA spend their time deepening relationships with an established base of clients and organically growing their practice through referrals to deliver financial solutions that ignite the dreams of the people we exist to serve. We are proud that we've been recognized for being one of the world's most ethical companies and ranked by Diversity Inc as a Top 50 Company for diversity. We hire and develop Advisors who believe in our mission of helping our clients find confidence in retirement and who personify our values. Should the following skills reflect who you are and who you aspire to be, you will thrive as an Advisor at TIAA. Deeply curious with a demonstrated ability to uncover the needs of the client. Giving and receiving constructive feedback are hallmarks of your character. Unlocking the value of bringing people together to leverage their skills, talents,...

Dec 26, 2025
TIAA
Senior Portfolio Manager, Private Asset Management (Philadelphia, PA)
TIAA Philadelphia, PA, USA
Sr. Portfolio Manager, Private Asset Management The Sr. Portfolio Manager, Private Asset Management leads the delivery of investment strategies for complex client relationships, bringing a deep understanding of financial markets and a tailored approach to investment management. This role involves strategic thinking, trust-building with clients, mentoring talent, and shaping broader investment approaches. Key Responsibilities and Duties Lead investment management for high-value client relationships with sophisticated needs. Ensure operational accuracy, compliance, and high-touch client servicing. Create and adjust asset allocation strategies to align with evolving client goals. Conduct in-depth portfolio reviews and guide long-term wealth planning conversations. Mentor Associate Portfolio Managers and Portfolio Managers to elevate team capabilities. Contribute to team investment philosophy and tactical allocation decisions....

Dec 26, 2025
TIAA
Wealth Management Advisor-Radnor, PA, Philadelphia, PA, State College, PA
TIAA Radnor, PA, USA
Wealth Management Advisor Supported with a robust array of resources and solutions, Advisors at TIAA spend their time deepening relationships with an established base of clients and organically growing their practice through referrals to deliver financial solutions that ignite the dreams of the people we exist to serve. We are proud that we've been recognized for being one of the world's most ethical companies and ranked by Diversity Inc as a Top 50 Company for diversity. We hire and develop Advisors who believe in our mission of helping our clients find confidence in retirement and who personify our values. Should the following skills reflect who you are and who you aspire to be, you will thrive as an Advisor at TIAA. Deeply curious with a demonstrated ability to uncover the needs of the client. Giving and receiving constructive feedback are hallmarks of your character. Unlocking the value of bringing people together to leverage their skills, talents,...

Dec 23, 2025
Highmark Health
Director of Data Product Management
Highmark Health Harrisburg, PA, USA
Company : Highmark Health Job Description : JOB SUMMARY The Director of Data Product Management is a leadership role responsible for developing, implementing, and continually refining our customer data product strategy from its foundational stages. This individual will define, develop, and execute the strategy for our core customer data products, ensuring they meet the evolving needs of Highmark and our customers. This individual will lead a team of product managers and analysts focused on specific areas of customer data, driving the realization of our Customer Data Product Strategy vision to empower downstream teams with personalized, high-quality, and timely interactions. This role requires a strong leader who can translate strategic opportunities into actionable product roadmaps, champion data quality and governance, and foster a data-driven culture. A robust technical background and the ability to effectively collaborate with engineering teams are paramount to...

Dec 23, 2025
TIAA
Wealth Management Advisor-Allentown, PA
TIAA PA, USA
Wealth Management Advisor Supported with a robust array of resources and solutions, Advisors at TIAA spend their time deepening relationships with an established base of clients and organically growing their practice through referrals to deliver financial solutions that ignite the dreams of the people we exist to serve. We are proud that we've been recognized for being one of the world's most ethical companies and ranked by Diversity Inc as a Top 50 Company for diversity. We hire and develop Advisors who believe in our mission of helping our clients find confidence in retirement and who personify our values. Should the following skills reflect who you are and who you aspire to be, you will thrive as an Advisor at TIAA. Deeply curious with a demonstrated ability to uncover the needs of the client. Giving and receiving constructive feedback are hallmarks of your character. Unlocking the value of bringing people together to leverage their skills, talents,...

Dec 23, 2025
Highmark Health
Care Manager RN - Utilization Management (UM) Remote
Highmark Health Harrisburg, PA, USA
Company : Highmark Inc. Job Description : JOB SUMMARY This job implements effective utilization management strategies including: review of appropriateness of health care services, application of criteria to ensure appropriate resource utilization, identification of opportunities for referral to a Health Coach/case management, and identification and resolution of quality issues. Monitors and analyzes the delivery of health care services; educates providers and members on a proactive basis; and analyzes qualitative and quantitative data in developing strategies to improve provider performance/satisfaction and member satisfaction. Responds to customer inquiries and offers interventions and/or alternatives. ESSENTIAL RESPONSIBILITIES Implement care management review processes that are consistent with established industry and corporate standards and are within the care manager's professional discipline. Function in accordance with applicable state,...

Dec 22, 2025
Highmark Health
Full time
 
Care Manager RN - Utilization Management (UM) Remote
Highmark Health West Chester, PA, USA
Company : Highmark Inc. Job Description : JOB SUMMARY This job implements effective utilization management strategies including: review of appropriateness of health care services, application of criteria to ensure appropriate resource utilization, identification of opportunities for referral to a Health Coach/case management, and identification and resolution of quality issues. Monitors and analyzes the delivery of health care services; educates providers and members on a proactive basis; and analyzes qualitative and quantitative data in developing strategies to improve provider performance/satisfaction and member satisfaction. Responds to customer inquiries and offers interventions and/or alternatives. ESSENTIAL RESPONSIBILITIES Implement care management review processes that are consistent with established industry and corporate standards and are within the care manager’s professional discipline. Function in accordance with applicable state, federal...

Dec 21, 2025
Highmark Health
Full time
 
Producer Management Strategy Consultant
Highmark Health Pittsburgh, PA, USA
Company Highmark Inc. Job Description JOB SUMMARY This job manages the regional Producers and Consultancies in our Highmark footprint (PA, DE, NY and WV). Through the use of analytics, education, go to market strategy and maintaining influential relationships, this role will serve as the liaison between Enterprise Diversified Businesses, Allegheny Health Network and other affiliated Health Systems, Product & Healthcare Services, Health Plan Operations, Actuarial Services, and Government and Commercial Market sales. Provide recommendations to internal processes and business leaders to better service distributors, and accelerates new and existing glide paths to business. The role will act as the “face” of the Organization’s producer strategy & administration team both internally and externally and as an enterprise leader to the producer community. ESSENTIAL RESPONSIBILITIES Enterprise-wide Strategy manage internal and external forums to ensure full...

Dec 20, 2025
Highmark Health
Medical Director, Medical Management
Highmark Health Harrisburg, PA, USA
Company : Highmark Inc. Job Description : JOB SUMMARY This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and appropriateness of the requested treatment of service. Depending on the nature of the case, telephonic peer to peer discussions may be required. The incumbent ensures compliance to NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member of the multidisciplinary team for case and disease management. They will advise the multidisciplinary team on cases, particularly high-risk cases, through the team structure. Additionally, the incumbent may be assigned special projects to help support and improve the care of our members...

Dec 15, 2025
PNC
Full time
 
Executive Client Relations Specialist - Office of the Customer
PNC Pittsburgh, PA, USA
Job Profile Position Overview At PNC, our people are our greatest differentiator and competitive advantage in the markets we serve. We are all united in delivering the best experience for our customers. We work together each day to foster an inclusive workplace culture where all of our employees feel respected, valued and have an opportunity to contribute to the company’s success. As an Executive Client Relations Specialist you will be within PNC's Office of the Customer (OOTC) organization, supporting Executive Client Relations (ECR). This is a remote position. Work may be performed from a quiet, confidential space in a home location, approved by PNC. This position may not be available in all geographic locations. The schedule for this position is Monday through Friday from 8:00am to 5:00pm EST. **Prior Retail Support/Escalations experience is preferred for this opportunity** Preferred experience in: Complaint resolutions, Complaint Management Systems &...

Dec 31, 2025
Highmark Health
Full time
 
Executive Assistant - J274032
Highmark Health Pittsburgh, PA, USA
Company Highmark Health Job Description JOB SUMMARY This job is part of an executive administrative team. This job provides administrative support to more than one Vice President and/or Senior Vice President. Incumbents will rely on experience and judgment to complete responsibilities, plan, accomplish goals and meet deadlines, and is required to be a consummate professional with a demonstrated record of enabling executives to carry out their duties with high effectiveness and efficiency. This job will have latitude in work project and requires a highly self-motivated with strong work ethic, diplomacy, political awareness, multi-tasking capabilities and the ability to execute their work by prioritizing tasks in a fast-paced environment. ESSENTIAL RESPONSIBILITIES Communicate effectively both in person and virtually to all levels in the organization. Display effective communication skills while interacting and responding, both written and verbally, with...

Dec 31, 2025
IG
Full time
 
Executive Assistant & Life Manager to the CEO
Intermedia Group Inc Exton, PA, USA
About the Role We are a $10M and growing company seeking a highly capable Executive Assistant & Life Manager to serve as a trusted extension of our CEO. This role ensures the smooth operation of executive business functions while also managing family, household, and life logistics. The position combines the discipline of a top-tier corporate executive assistant with the foresight and care of a family COO — handling the details so the CEO can focus on vision, leadership, and growth. You’ll act as a second brain, chief organizer, and right hand for both business and personal affairs. This is not a traditional assistant role. You will operate as a Chief of Staff + Lifestyle Manager , entrusted with the details of both the business and the family. It’s a rare opportunity to step into a role of influence, impact, and trust — one where your organizational and lifestyle management skills will directly enable the CEO to focus on vision, growth, and presence with family....

Dec 30, 2025
Highmark Health
Manager Healthcare Analytics - Medical Policy
Highmark Health Harrisburg, PA, USA
Company : Highmark Inc. Job Description : JOB SUMMARY This job is responsible for the oversight and operations of the healthcare management analytics function with the Medical Policy department. The incumbent retains responsibility for development, implementation and management of complex analytical, research, and decision support activities which includes complex analysis, including statistical analysis, quantitative analysis, predictive modeling, data mining, segmentation modeling, campaign evaluation, simulation model implementation and testing, and content knowledge. Provides consultation and analytical expertise in the development and support of various projects and data analysis related to Medical Policy and Utilization Management. ESSENTIAL RESPONSIBILITIES Perform management responsibilities including, but not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and...

Dec 27, 2025
Eliassen Group
Product Manager - Legal, Compliance, Policy Transformation
Eliassen Group Harrisburg, PA, USA
Product Manager - Legal, Compliance, Policy Transformation Anywhere Type: Contract Category: Product Management Industry: Technology Workplace Type: Remote Reference ID: JN -122025-104798 Date Posted: 12/18/2025 Shortcut: http://careers.eliassen.com/3GSfo0 Description Recommended Jobs Description: 100% Remote Our client is seeking a Product Manager to lead the digital transformation of their Legal, Compliance, and Policy Organization (LCPO). As a key member of FLP Tech, you will act as the strategic bridge between legal business functions and technology execution. Due to client requirement, applicants must be willing and able to work on a w2 basis. For our w2 consultants, we offer a great benefits package that includes Medical, Dental, and Vision benefits, 401k with company matching, and life insurance. Rate: $80 - $90 / hr. w2 Responsibilities: What You'll Do Drive the Build vs. Buy Strategy:...

Dec 26, 2025
TB
Full time
 
Store Manager II- Lansdale, PA
TD Bank Lansdale, PA, USA
Work Location: Lansdale, Pennsylvania, United States of America Hours: 40 Pay Details: $91,000 - $136,240 USD TD is committed to providing fair and equitable compensation opportunities to all colleagues. Growth opportunities and skill development are defining features of the colleague experience at TD. Our compensation policies and practices have been designed to allow colleagues to progress through the salary range over time as they progress in their role. The base pay actually offered may vary based upon the candidate's skills and experience, job-related knowledge, geographic location, and other specific business and organizational needs. As a candidate, you are encouraged to ask compensation related questions and have an open dialogue with your recruiter who can provide you more specific details for this role. Line of Business: Personal & Commercial Banking Job Description: The Store Manager II develops, leads and contributes to the growth...

Dec 25, 2025
Eliassen Group
Data Governance Project Manager
Eliassen Group Harrisburg, PA, USA
Data Governance Project Manager Anywhere Type: Contract Category: Program/Project Management Industry: Retail Workplace Type: Remote Reference ID: JN -122025-104773 Date Posted: 12/16/2025 Shortcut: http://careers.eliassen.com/9ivAqu Description Recommended Jobs Description: * 100% remote working EST hours * We are seeking an experienced Senior Project Manager to support our client's growing Enterprise Data Governance Program . This role sits at the intersection of program leadership, data governance, cross-functional communication, and operational excellence. This is a high-visibility role supporting a transformational program - ideal for someone who is organized, proactive, structured, and confident partnering with legal, privacy, security, and technology teams . It is not a traditional IT project manager role. Instead, you will help drive program-level strategy, governance workflows, and...

Dec 24, 2025
Highmark Health
Full time
 
Client Project Manager (EPIC Experience Required)
Highmark Health Pittsburgh, PA, USA
Company Highmark Health Job Description JOB SUMMARY A successful IT Project Manager for clinical initiatives in Pittsburgh will demonstrate deep expertise in both information technology and healthcare environments, seamlessly integrating industry terminology and best practices from both domains. This individual will have a proven track record managing Epic projects, potentially working with vendors, ensuring alignment with clinical workflows and regulatory requirements. Highly organized and adaptable, the candidate excels at switching between competing priorities while maintaining professionalism and tact in all interactions. Resilience and a solutions-oriented mindset enable effective navigation of complex challenges, and strong communication skills foster collaboration across multidisciplinary teams. This professional approach ensures the delivery of impactful, patient-centered technology solutions that advance organizational goals. This individual must...

Dec 22, 2025
Co
Sales Team Lead (Liquor Store Clerk 2)- Lake Raystown Shopping Center, Huntingdon
Commonwealth of Pennsylvania Pennsylvania
Sales Team Lead (Liquor Store Clerk 2)- Lake Raystown Shopping Center, Huntingdon Print (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/5169214) Apply ? Sales Team Lead (Liquor Store Clerk 2)- Lake Raystown Shopping Center, Huntingdon Salary $38,768.00 - $57,702.00 Annually Location Huntingdon County, PA Job Type Civil Service Permanent Full-Time Job Number CS-2025-38461-02130 Department Liquor Control Board Division LC Str 3101 Opening Date 12/16/2025 Closing Date 12/29/2025 11:59 PM Eastern Job Code 02130 Position Number 00108017 Union UFCW Bargaining Unit M1 Pay Group LS07 Bureau / Division Code Store # 3101 Bureau / Division Retail Operations, Store Region 3 Worksite Address 7657 Lake Raystown Shopping Center City Huntingdon, Pennsylvania Zip Code 16652 Contact Name Jennifer Mills Contact Phone 717.307.2021 Contact Email jennmills@pa.gov Description Benefits...

Dec 22, 2025
Fu
Bioprocess Specialist Manager
Fujifilm Harrisburg, PA, USA
Position Overview Position Description We are hiring a Bioprocess Specialist Manager. The Bioprocess Specialist Manager will be responsible for sales and support for all FujiFilm Life Science Bioprocess products and services in their region. This is an individual contributor position. MUST BE BASED IN Northeast or Southeast US Market. Region covers entire northeast and southeast market from Quebec to Florida including LA, MS, TN, AL, WV, GA, SC, NC, VA, MD, DE, NJ, PA, NY,NH, MA, RI, VA and ME. Company Overview At FUJIFILM Irvine Scientific (dba FUJIFILM Biosciences), we turn curiosity into breakthroughs that advance the field of life sciences. By offering a comprehensive portfolio of products and services in cell culture media, discovery research reagents, recombinant growth factors and proteins, fine chemicals, and critical assay materials, we partner with the brightest minds in biotech and pharma to tackle the world's biggest health challenges. Imagine...

Dec 21, 2025
Highmark Health
Sr. Client Manager - HNAS
Highmark Health Harrisburg, PA, USA
Company : Highmark Inc. Job Description : JOB SUMMARY This job is responsible for managing a book of business and the business relationship as a strategic consultant for existing accounts directly or through intermediaries within the TPA and Self Funded space. The incumbent is responsible for renewing accounts and selling new products and services to existing accounts to ensure retention and growth of profitable business. HNAS (Health Now Administrative Services) offers flexible, cost-effective solutions for employee health benefits. HNAS is part of Highmark Health, a national blended health organization with a mission to create remarkable health experiences. Our culture is built on your growth and development, collaborating across our organization, and making a big impact for those we serve This role is looking for someone who has experience with health insurance and has worked with TPA, Stop loss, and self-funded clients. ESSENTIAL RESPONSIBILITIES...

Dec 21, 2025
Highmark Health
Complex Case Manager RN - Oncology
Highmark Health Harrisburg, PA, USA
Company : Highmark Inc. Job Description : JOB SUMMARY This job has primary ownership and oversight over a specified panel of 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. The incumbent will be supported by a multi-disciplinary team and will use clinical judgment to refer members to appropriate multi-disciplinary resources. 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 conducts outreach to members enrolled in case management including but is not limited to: developing a care plan, encouraging behavior changes, identifying and addressing barriers, helping members to coordinate...

Dec 21, 2025
Highmark Health
Supervisor Intake Coordination
Highmark Health Harrisburg, PA, USA
Company : Highmark Inc. Job Description : JOB SUMMARY This job supervises and coordinates the day-to-day activities of the UM Intake Coordination team. The incumbent selects, develops and continuously coaches staff to the highest levels of performance. Motivates and team builds through the creation of a work environment and conditions that contribute to highest levels of performance. ESSENTIAL RESPONSIBILITIES Perform management responsibilities including, but limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.Plan, organize, staff, direct, and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority. Determine workflow for the day and assign work to the team.Monitor and manage daily inventories to ensure adequate staffing and resources are...

Dec 21, 2025
VI
Engineering Program Manager
Veeco Instruments Horsham, PA, USA
Reference #: 1333779300 Select how often (in days) to receive an alert: Apply now Engineering Program Manager Location: US - PA - Horsham Requisition ID: 19512 About Veeco You probably don't realize it, but what we do at Veeco touches the lives of every person, every day. It's a bold statement, but it's true. From the smartphones in our pockets that access the world's collective knowledge, to the cloud-based services where all that information lives, to high-speed wireless communication and computing power needed to drive artificial intelligence, augmented and virtual reality, gaming and so much more, our technology is all around us. We design, develop, manufacture, and service highly complex, cutting-edge machines used by our customers to create the essential devices that drive the digital age, connect the world, and improve the human experience. Along with the world's leading technology companies, many of which are household names, we help solve their most...

Dec 21, 2025
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