64 policy officer jobs found

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us. Job Posting Title Senior Compliance Analyst (Regulatory Change Management) - Remote Job Description The Senior Compliance Analyst assists in the implementation of Prime's compliance programs and leads initiatives within their designated areas. This role partners with key internal stakeholders to monitor aspects of compliance and validate policies, procedures, licensure, and program manuals are effectively followed and maintained. Responsibilities Executes compliance procedures and enforces policy governance across the organization to validate regulatory reporting requirements are met and that business operations are aligned with expectations of applicable regulatory guidance Lead project management efforts for highly sensitive...

Become a part of our caring community and help us put health first The Director, Home Health Risk Management identifies and analyzes potential sources of risk, proactively ensuring controls and processes are in place to reduce risk. The Director, Home Health Risk Management requires an in-depth understanding of how organization capabilities interrelate across the Home Health segment. The Director of Risk Management for Home Health will be responsible for development and implementation of controls and cost-effective approaches to minimize risks to the organization as well as estimating the potential consequences of risks. Assesses and communicates information regarding business risks with functions across the organization. Their focus will be on CenterWell risk assessments, issue management, auditing and monitoring. Areas of oversight will include CenterWell Home Health, OneHome, as well as new growth initiatives. This role requires an in-depth understanding of Home Health...

Become a part of our caring community and help us put health first Encounter Data Management Professional is responsible for ensuring accurate submission and reconciliation of encounter data to Medicaid and Medicare through effective business processes. Ensures claims submissions meet or exceed all compliance standards via analysis of data and develops tools to enhance the encounter acceptance rate by Medicaid/Medicare. Looks for long-term improvements of claims submission processes. Takes ownership by applying professional standards, regulations, and strategies within their work area. Independently sets priorities and makes decisions on work approach while following established direction. Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation. Humana's Encounter Data Management (EDM) team is seeking an Encounter Data Management Professional that has experience with business processing and data...

Company : Highmark Health Job Description : GENERAL OVERVIEW Flexible Work Arrangements: At Highmark, we value both collaboration and flexibility. For this role, if you are located within 50 miles of Pittsburgh or any Highmark office, you'll enjoy a hybrid schedule, working from the office three days a week (Tuesday, Wednesday, and Thursday). If you live beyond this 50-mile radius, you'll primarily work remotely, with an expectation of traveling to an office location for team-focused building meetings a maximum of 1-2 times annually. This job is responsible for the successful definition, implementation and delivery of complex programs that requires cross-functional collaboration and interdependencies between a group of projects and/or related activities within the constraint of scope, quality, time and budget and under circumstances involving multiple moderate-probability, moderate-impact risk factors. Manages a matrix group of employees and contractors who...

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...

Company : Highmark Health Job Description : JOB SUMMARY This is a hybrid role if you live within a 50 mile radius of one of our office locations in PA, NY or DE This role is responsible for contributing to the product strategy and roadmap for a defined product area, by managing a team while working under the direction of leadership. This role focuses on deeply understanding customer needs, market trends, and competitive landscape to inform product development decisions. The incumbent works cross-functionally to manage a team that is executing a portfolio roadmap or portfolio of product roadmaps and delivering high-quality products that meet business objectives. They will manage the product backlog for a specific product or feature set. ESSENTIAL RESPONSIBILITIES Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance...

Become a part of our caring community and help us put health first Care Manager Support Assistants assist in ensuring TRICARE beneficiaries receive the highest quality health care for Autism Spectrum Disorder (ASD) related services in accordance with the Autism Care Demonstration (ACD). This role supports the Autism Service Navigator (ASN) by verifying eligibility for the ACD and monitoring and supporting the family for 180 to assist with any barriers to accessing services; education and initial registration into ECHO registration portal for active duty family members; assistance with regional transfers and ensuring the receiving Managed Care Support Contractor receives the appropriate paperwork; processes faxes for ECHO eligibility or other paperwork pertaining to ACD requirements such as eligibility, referrals, etc.; and identification of ABA providers and researching necessary resources to support the beneficiary. KEY ACCOUNTABILITIES Assist beneficiaries with...

Company : Highmark Health Job Description : JOB SUMMARY *This will be a hybrid role if you live within a 50 mile radius a Highmark Office This senior-level job will lead and facilitate integrated process improvement and change management initiatives across multiple functional units Responsibilities encompass designing and implementing process optimization strategies, developing and executing comprehensive change management plans across all impacted stakeholders throughout the change lifecycle, coaching leaders and teams as applicable, and ensuring seamless alignment between people, process, and technology solutions - all while directly contributing to successful business outcomes and ongoing improvements. The successful candidate will leverage expertise in Lean Six Sigma, as well as change management methodologies to drive efficiency, effectiveness, and improved business outcomes. ESSENTIAL RESPONSIBILITIES Process Improvement and Change Management...

Become a part of our caring community and help us put health first The Workforce Management Professional 1 applies and integrates advanced and predictive analysis, people metrics and reporting to develop strategic and operational insights for workforce decision-making (e.g., staffing, learning and development, talent management, diversity and human resource compliance). The Workforce Management Professional 1 work assignments are often straightforward and of moderate complexity. The Workforce Management Professional 1 assesses organizational staffing and identifies requirements and solutions to meet workforce objectives. Provides analysis of talent and staffing needs based on strategic planning at the enterprise level. Understands own work area professional concepts/standards, regulations, strategies and operating standards. Makes decisions regarding own work approach/priorities, and follows direction. Work is managed and often guided by precedent and/or documented...

Become a part of our caring community and help us put health first Humana is evolving its marketing operations to enable smarter planning, faster execution, and greater transparency-and we're looking for a product manager to lead that effort. As Senior Associate/Product Manager - Marketing Resource Management (MRM) Capabilities, you'll own the roadmap for tools and workflows that support campaign intake, planning, approvals, and performance tracking. This role is central to enabling scalable, compliant, and insight-driven marketing operations. You'll help guide the transition to a modern resource management platform and evaluate opportunities to integrate with enterprise workflow systems to support intelligent orchestration. This role supports the day-to-day configuration and optimization of marketing resource management tools and workflows. You'll work closely with cross-functional teams-including Marketing, Creative, Legal, and IT-to ensure campaign planning and...

Become a part of our caring community and help us put health first With over 10 million sales interactions annually, Humana understands that while great products are important, it's the quality of our service that truly defines us. We know that when our members and prospects have delightful and memorable experiences, it strengthens their connection with us and enables us to put their Health First. After all, a health services company that has multiple ways to improve the lives of its customers is uniquely positioned to put those customers at the center of everything it does. The Lead Product Owner is responsible for conveying product vision and roadmap to an Agile delivery team by defining user stories and prioritizing product backlog. The Lead Product Owner works on problems of diverse scope and complexity ranging from moderate to substantial. This role will be aligned to Humana sales technology platforms, helping further advance capabilities that provide a seamless...

Become a part of our caring community and help us put health first The Associate Director, Finance Data Management supports all aspects of configuration control, data management, and deficiency reporting. The Associate Director, Finance Data Management requires a solid understanding of how Finance organization data capabilities interrelate across department(s). The Associate Director, Finance Data Management supports implementation of government and industry policies for requirements management, document management, change management, production and delivery, and configuration management of the performance, functional, and physical baselines. Acquires, validates, stores, protects, and processes required data to ensure the accessibility, reliability, and timeliness of the data for its users. Develops and executes architecture, policies, practices and procedures that properly manage the full data lifecycle needs of an enterprise. Decisions are typically related to identifying...

Become a part of our caring community and help us put health first The Senior Workforce Management Professional applies and integrates advanced and predictive analysis, people metrics and reporting to develop strategic and operational insights for workforce decision-making (e.g., staffing, learning and development, talent management, diversity and human resource compliance). The Senior Workforce Management Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Senior Forecasting Analyst plays a pivotal role in shaping strategic workforce planning through advanced forecasting methodologies, comprehensive data analysis, and insightful consultation. This position is responsible for overseeing and refining staffing forecasts, optimizing resource allocation for contact center and back-office operations, and driving continuous improvement in workforce management...

Become a part of our caring community and help us put health first We are looking for a dynamic Lead Product Manager to develop clinical solutions for our members and providers, with full accountability from strategy to execution. The Lead Product & Strategy Manager - Provider Practice Management role is a critical member of the multidisciplinary clinical initiatives team within Clinical Strategy and Analytics. This role is not a traditional software product manager role. Instead, it requires demonstrated expertise in healthcare delivery, provider performance improvement, operational redesign, and translating insights into actionable workflows for clinical practices. The Lead Product & Strategy Manager will work across clinical initiatives focused on reducing 30-day Plan All-Cause Readmissions (PCR). They will partner closely with high-performing and low-performing provider groups to identify clinical best practices, understand operational gaps, and design and...

Become a part of our caring community and help us put health first The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting medical necessity and comprehensive medication reviews for prescriptions requiring prior authorization. This role involves evaluating complex clinical scenarios and applying evidence-based criteria to ensure appropriate medication use. The pharmacist addresses moderately complex to complex issues that require critical thinking and in-depth analysis of variable factors. Earn a $5,000 hiring bonus! Bonus is paid after 180 days of employment; you must be employed until that date to be eligible to receive the payment." Location: Remote - United States Schedule: 8-hour shifts, Monday through Friday, between 10:30 AM and 11:00 PM EST OR 10-hour shifts, Tuesday through Friday, between 10:30 AM and 11:00 PM EST Required to work every 5th Saturday Required to work 1 company holiday...

We are seeking a dynamic and strategic Digital Strategist / Change Management to lead clients through the change management lifecycle as part of value realization engagements. This role is pivotal in enabling marketing organizations to unlock growth, improve performance, and accelerate digital transformation by aligning people, processes, and platforms. You'll partner with executive sponsors and product owners to activate prioritized use cases, accelerate adoption, and institutionalize new ways of working. Key Responsibilities: Change Management & Enablement Lead stakeholder mapping, sponsorship models, and governance; run change impact assessments and readiness plans. Design and deliver enablement (role-based training, playbooks, office hours) for marketers, analysts, data engineers, and journey designers. Orchestrate communication plans and feedback loops to sustain adoption and continuously improve ways of working. Operating Model &...

We are seeking a Wireless Communications Systems Manager to support the Kirtland C4 program at Kirtland AFB in Albuquerque, New Mexico. TekSynap is a fast-growing high-tech company that understands both the pace of technology today and the need to have a comprehensive well planned information management environment. “Technology moving at the speed of thought” embodies these principles – the need to nimbly utilize the best that information technology offers to meet the business needs of our Federal Government customers. We offer our full-time employees a competitive benefits package to include health, dental, vision, 401K, life insurance, short-term and long-term disability plans, vacation time and holidays. Visit us at www.TekSynap.com. Apply now to explore jobs with us! The safety and health of our employees is of the utmost importance. Employees are required to comply with any vaccination requirements mandated by contract, applicable law or regulation....

"We enable greatness in people and organizations everywhere. " FranklinCovey (NYSE: FC) is the workplace of choice for Achievers with Heart . We are one of the largest and most trusted leadership companies in the world, with directly owned and licensee partner offices in over 160 countries and territories. With more than 2,000 global associates, FranklinCovey transforms organizations by partnering with clients to build leaders, teams, and cultures that get breakthrough results through collective action. Our services and products are primarily delivered through our subscription offerings, which are comprised of the FranklinCovey All Access Pass, which is primarily sold through our Enterprise Division, and the Leader in Me membership, which is designed specifically for our Education Division. Enterprise clients include Fortune 100 , Fortune 500 , thousands of small and mid-sized businesses, and numerous government entities. FranklinCovey Education has shared our...

Work at Home - Decision Quality and Controls, Principal Process Manager Decision Quality and Controls is the face of Monitoring and Controls for Customer Protection. We take Quality monitoring to the next level by designing controls that are criteria based targeting key failure modes and testable meeting Enterprise Standards. We are looking for a process engineer with expertise in Data and Reporting that will fast track us into automation. In this role you will partner with key stakeholders across Retail Bank Fraud to automate and enhance dashboards, processes and reporting and craft compelling stories backed by data. What We're Looking For In This Role: Drive forward strategy for execution of controls support including process assessments and enhancements, make recommendations and influence change Leads, influences, and mentors associates within a dotted line team through large and/or complex process or projects with significant impact, delegating and...

Become a part of our caring community and help us put health first The Manager, Fraud and Waste conducts investigations of allegations of fraudulent and abusive practices. The Manager, Fraud and Waste works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals. Where You Come In The Manager, Fraud and Waste coordinates investigation with law enforcement authorities. Assembles evidence and documentation to support successful adjudication, where appropriate. Conducts on-site audits of provider records ensuring appropriateness of billing practices. Prepares complex investigative and audit reports. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration, and conducts briefings and...

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...

About HUB In a rapidly changing world, HUB advises businesses and individuals on how to prepare for the unexpected. As one of the world’s largest insurance brokers, our focus is dedicated to providing our customers with the peace of mind that what matters most will be protected — through unrelenting advocacy and tailored insurance solutions that put our clients in control. Our growing team of professionals across North America represents a broad, deep and one-of-a kind aggregation of entrepreneurs and leaders recognized for their excellence throughout the insurance community. Why Choose HUB? Throughout our network of more than 600 HUB offices in North America, we offer a competitive, exciting and friendly work environment that strategically positions our employees for longevity and success. At HUB, we believe in investing in the future of our employees and provide continuous opportunities for growth and development. Our entrepreneurial culture fosters an environment that...

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:...

About HUB In a rapidly changing world, HUB advises businesses and individuals on how to prepare for the unexpected. As one of the world’s largest insurance brokers, our focus is dedicated to providing our customers with the peace of mind that what matters most will be protected — through unrelenting advocacy and tailored insurance solutions that put our clients in control. Our growing team of professionals across North America represents a broad, deep and one-of-a kind aggregation of entrepreneurs and leaders recognized for their excellence throughout the insurance community. Why Choose HUB? Throughout our network of more than 600 HUB offices in North America, we offer a competitive, exciting and friendly work environment that strategically positions our employees for longevity and success. At HUB, we believe in investing in the future of our employees and provide continuous opportunities for growth and development. Our entrepreneurial culture fosters an environment that...