2 health teacher jobs found

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 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...