176 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...

Reference #: 41161 Construction Quality Assurance Manager Position will work as primary contact for all quality issues for job site while coordinating inspections, supervising contractors, and creating daily reports. Compensation & Benefits: Estimated Starting Salary Range for Construction Quality Control Manager: $120K- $140K Pay commensurate with experience. Full time benefits include Medical, Dental, Vision, 401K and other possible benefits as provided. Benefits are subject to change with or without notice. Construction Quality Control Manager Responsibilities Include: Primary point of contact for quality issues on the job site. Field Supervision of contractors. Coordination of inspections. Creating, collecting, and completing daily reports. Communication with clients. Set an example on-site regarding quality and safety policies and project specific procedures. Performs other job-related duties as assigned. Construction Quality...

Reference #: 19636 Duquesne Light Company, headquartered in downtown Pittsburgh, is a leader in providing electric energy and has been in the forefront of the electric energy market, with a history rooted in technological innovation and superior customer service. Today, the company continues its role as a leader in the transmission and distribution of electric energy, providing a secure supply of reliable power to more than half a million customers in southwestern Pennsylvania. Duquesne Light Company is committed to creating a culture of inclusion. We value and respect the unique differences and experiences of our employees. We believe that our differences lead to better collaboration, innovation and outcomes. We want you to join our team! TheSenior Engineer, Asset Management will develop engineering solutions to complex issues, serve as a subject matter expert on substation equipment issues to groups within and outside of Asset Management, and provide mentoring and guidance...

As the Team Leader, LTD Claims Case Management , you will be responsible for validating that all LTD claims are accurately and fairly adjudicated according to plan provisions, established best practices and within state and federal guidelines. As the Team Leader you must be able to manage and resolve issues that pertain to claim administration procedures cost containment activities, reports and quality control issues. You will serve as primary resource for the team and provide direction to the staff members by setting objectives, communicating progress and goals, and holding the staff accountable for adhering to all quality assurance, turnaround times, best practice standards, and operational efficiency. You are also responsible for assisting staff with career development and career progression. The Team Leader partners with internal cross functional areas for program direction, goal setting, service delivery and development of action plans and leveraging bench strength. You...

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...

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,...

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....

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. Collaborate with legal, tax,...

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...

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,...

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...

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,...

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,...

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...

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...

Summary The Senior Social Worker practices within the Wilkes-Barre VAMC Pain Management Clinic providing inpatient and outpatient services. These services include intake, assessment, case management, advocacy, treatment, coordination of care and discharge planning with appropriate VA and community service providers and agencies as needed and directed by the Veteran. The Senior Social Worker serves a patient population with highly complex pain, mental health, and substance use comorbidities. This job is open to The public U.S. Citizens, Nationals or those who owe allegiance to the U.S. Federal employees - Excepted service Current federal employees whose agencies have their own hiring rules, pay scales and evaluation criteria. Duties The incumbent has advanced and expert skill in a range of specialized interventions and treatment modalities used in specialty treatment programs or with special patient populations. This includes...

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 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 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...

Company Allegheny Health Network Job Description GENERAL OVERVIEW This job supports and enhances the activities of the practice by providing administrative and clinical support and coordinating daily operations. Essential Responsibilities Coordinates and oversees clerical and clinical functions. Coordinates and/or performs clinical support duties not limited to preparing exam rooms, rooming patients to obtain health and physical information, and assisting healthcare providers in the delivery of patient care during exams, procedures, testing and administering injections. Schedules patients for procedures, diagnostic testing, and/or office visits. Provides patients with instructions and serves as liaison between the physician and patients. Maintains physician(s) calendars. Screens and directs telephone calls as appropriate. Takes appropriate actions and responds to internal and external customer inquiries. Supports front office including registration, chart...

Company Allegheny Health Network Job Description Job Description $1,000 Sign-On Bonus Sign-On bonus is for External Hires only Recipient must stay with AHN for a minimum of 1 year Re-Hires may not have worked for AHN within the previous 12 months to qualify General Overview This job supports and enhances the activities of the practice by providing administrative and clinical support and coordinating daily operations. Essential Responsibilities Coordinates and oversees clerical and clinical functions. Coordinates and/or performs clinical support duties not limited to preparing exam rooms, rooming patients to obtain health and physical information, and assisting healthcare providers in the delivery of patient care during exams, procedures, testing and administering injections. Schedules patients for procedures, diagnostic testing, and/or office visits. Provides patients with instructions and serves as liaison between the physician and patients....

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: This job supports and enhances the activities of the practice by providing administrative and clinical support and coordinating daily operations. ESSENTIAL RESPONSIBILITIES: Coordinates and oversees clerical and clinical functions. Coordinates and/or performs clinical support duties not limited to preparing exam rooms, rooming patients to obtain health and physical information, and assisting healthcare providers in the delivery of patient care during exams, procedures, testing and administering injections. Schedules patients for procedures, diagnostic testing, and/or office visits. Provides patients with instructions and serves as liaison between the physician and patients. Maintains physician(s) calendars. Screens and directs telephone calls as appropriate. Takes appropriate actions and responds to internal and external customer inquiries. Supports front office...

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...