41 english teacher jobs found in Topeka

Company : Highmark Health Job Description : JOB SUMMARY This job works on transformation initiatives in healthcare for clients and members. Will develop and execute member engagement strategies to drive the transformation of healthcare for clients and members, including executing events and campaigns across the commercial, Medicare and community segments. The incumbent works with highly complex members and with high priority clients and projects to execute transformation initiatives. The incumbent mentors more junior level members. Educates members about how their insurance benefits work, the financial impact of healthcare choices, available provider/service options and the importance of getting the right care at the right time, in the right place. Will play a major role in driving change in member behavior and driving overall business outcomes from a cost of care perspective. responsible for growth centered on transformation and change in healthcare; including the...

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...

Company : enGen Job Description : JOB SUMMARY We are seeking a skilled and proactive Mid-Level Database Administrator to join our strong, dedicated, and experienced team. The ideal candidate will primarily focus on the reliable operation, maintenance, and performance of our on-prem SQL Server environments. A foundational understanding of cloud database concepts, particularly Google Cloud SQL, is important, coupled with a strong willingness to learn and grow across diverse database platforms, including Postgres and MySQL on Linux. They should possess strong communication skills and a keen understanding of automating database tasks and managing infrastructure as code to enhance efficiency. This role offers an excellent opportunity for professional growth within an experienced team, contributing to the support and evolution of critical database systems that underpin both our provider and payer side operations. Candidates should be capable of working independently...

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...

Company : Highmark Inc. Job Description : JOB SUMMARY This job collects, validates, analyzes, and organizes data into meaningful computerized reports by manipulating and extracting data to meet customer needs, generates reports through mainframe and/or PC applications by utilizing established applications/programs or developing new applications/programs, develops work plans to meet deadlines, accurately estimating completion dates and communicating report status to customers and management, and resolves business problems related to automated systems and provide data analysis and recommend solutions. 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...

Lensa is a career site that helps job seekers find great jobs in the US. We are not a staffing firm or agency. Lensa does not hire directly for these jobs, but promotes jobs on LinkedIn on behalf of its direct clients, recruitment ad agencies, and marketing partners. Lensa partners with DirectEmployers to promote this job for Highmark Health. Clicking "Apply Now" or "Read more" on Lensa redirects you to the job board/employer site. Any information collected there is subject to their terms and privacy notice. 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...

Company : Highmark Inc. Job Description : JOB SUMMARY This job reviews, evaluates, and processes various Stop Loss (Excess Risk and Reinsurance) claims in accordance with established turnaround and quality standards. Responsible for building positive client relationships, providing education, and analyzing client claim losses as well as current issues regarding client activities; disseminates necessary information to the management. Follows up on pended claims in accordance with department standards. 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. ESSENTIAL RESPONSIBILITIES Processes daily incoming Stop Loss claims including...

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 : enGen Job Description : JOB SUMMARY Candidates residing within a 50-mile radius of Highmark offices in Camp Hill, Buffalo, or Pittsburgh will be required to work a hybrid schedule, with in-office attendance on Tuesdays, Wednesdays, and Thursdays at one of these locations. Candidates whose primary residence is outside this 50-mile radius will also follow a hybrid work model. **CANDIDATE MUST BE US Citizen (due to contractual/access requirements) ** The Senior Information Risk Consultant serves as the strategic lead for M&A cybersecurity integration, driving governance and assurance across multiple concurrent acquisitions. This role establishes and manages the Cybersecurity Integration Management Office (C-IMO), ensuring seamless alignment of security requirements during pre- and post-acquisition phases. Beyond M&A, the position provides expert leadership in policy stewardship, control assurance, and information security program maturity,...

Company : Highmark Inc. Job Description : JOB SUMMARY This job will deliver value to the Health Plan, and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA), using skills including but not limited to Hierarchical Condition Category (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation (RADV) Audits. Works closely with physicians, team members, Quality, Compliance, partners at Enterprise and leadership to identify and deliver high quality and accurate risk adjustment coding. Supports all Remote Patient Monitoring (RPM) risk adjustment projects to comply with all CMS requirements by analyzing physician documentation and interpreting into ICD10 diagnoses and HCC disease categories. Supports other key objectives to drive capture of correct Risk Adjustment coding including...

Company : United Concordia Dental Job Description : JOB SUMMARY This job provides account support activities associated with the implementation and administration of groups and accounts. Provides assistance with non-standard benefit implementation tasks. Identifies and resolves problems related to benefit interpretations, non- standard benefits, handle rating concerns, and coordinate claim extracts and any subsequent adjudication requirements. The incumbent may have direct interaction with producers, clients and sales reps to ensure complete implementation, on-going service and all renewal activity. The incumbent is new to the role and is developing competence in performing work assignments. ESSENTIAL RESPONSIBILITIES Load and maintain group information and benefit files. Interact and provide support activities to Account Managers (For UCD: Accounts Support Analysts are account managers for all small market clients. May also be involved with managing...

Company : Highmark Health Job Description : JOB SUMMARY The Senior Marketing Analytics Analyst plays a critical role in transforming customer, digital, and campaign data into insights that improve acquisition, retention, member experience, and marketing effectiveness. This role works across Marketing, Digital, Sales, and Enterprise Analytics to translate business questions into analytical approaches, build performance dashboards, evaluate campaign ROI, and uncover opportunities to improve engagement across the member and patient lifecycle. This individual must bring strong statistical rigor, advanced marketing analytics skills, and deep understanding of healthcare customer journeys-including Medicare, Medicaid, Commercial, and provider engagement pathways. Experience with enterprise data platforms such as Salesforce Data Cloud, Adobe AEP/CJA, and Tableau is preferred. ESSENTIAL RESPONSIBILITIES Develops, evolves, and then communicates various digital...

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...

Company : Highmark Inc. Job Description : JOB SUMMARY This job is a non-clinical resource that coordinates, analyzes, and interprets the benefits and claims processes for clinical teams and serves as a liaison between various departments across the enterprise, including but not limited to, Clinical Strategy, Sales/Client Management, Customer Service, Claims, and Medical Policy. The person in this position must fully understand all product offerings available to Organization members and be versed in claims payment methodologies, benefits administration, and business process requirements. ESSENTIAL RESPONSIBILITIES Coordinate, analyze, and interpret the benefits and claims processes for the department. Serve as the liaison between the department and the claims processing departments to facilitate care/case management activities and special handling claims. Communicate benefit explanations clearly and concisely to all pertinent parties....

Company : Highmark Health Job Description : JOB SUMMARY: This job collaborates with Sales Client Management and the Sales Executive team. The position will develop member transition strategies to steer the transition of members to AHN and community providers; thereby minimizing future member disruption. This position is responsible for educating members about how their insurance benefits work, the financial impact of healthcare choices, available provider/service options and the importance of getting the right care at the right time, in the right place. The incumbent will play a major role in driving change in member behavior and driving overall business outcomes from a cost of care perspective. ESSENTIAL RESPONSIBILITIES: Empower members to make informed decisions by evaluating the most appropriate type of provider for members' unique needs, assess which providers are in-network and ensure that the members are fully informed of the tools and resources...

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...

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...

Company : enGen Job Description : JOB SUMMARY We are seeking a hands-on Principal Data Architect to serve as a leader in our ongoing data and digital transformation, leveraging a modern open data ecosystem build on foundational iceberg lakehouse patterns for both humans and AI to thrive. This role will own defining and delivering our enterprise strategy and architectural approach towards data movement [including integration and interoperability], Enrichment, and Orchestration. This scope will span the full enterprise of a complex hybrid ecosystem: We are not a skunkworks team just trying out new technology and you will make our implementations with dbt, airflow, kafka, and iceberg real for a $30B+ company impacting millions of lives across the country. Not only will this person be a leader of our rapid modernization but will insistently keep a business and customer first mentality. The right leader understands the efficiencies and innovations needed to transform...

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...

Company : Highmark Health Job Description : JOB SUMMARY This job plays a key role in ensuring projects (i.e. change initiatives) meet objectives on time and on budget by increasing employee adoption and usage of the change solution. The incumbent focuses on the people side of change - including changes to business processes, systems and technology, job roles and organization structures. Creates and implements change execution strategies and plans that maximize employee adoption and usage and minimize risk to implementation. Works to drive faster adoption, higher ultimate utilization and greater proficiency of the changes that impact employees in the organization to increase benefit realization, value creation, ROI and the achievement of results and outcomes. While this job does not have supervisory responsibility, the incumbent works through many others in the organization to succeed. Acts as a coach for senior leaders and executives in helping them fulfill the role...

Company : Highmark Inc. Job Description : JOB SUMMARY This job provides account support activities associated with the implementation and administration of groups and accounts. Provides assistance with non-standard benefit implementation tasks. Identifies and resolves problems related to benefit interpretations, non- standard benefits, handle rating concerns, and coordinate claim extracts and any subsequent adjudication requirements. The incumbent may have direct interaction with producers, clients and sales reps to ensure complete implementation, on-going service and all renewal activity. The incumbent has foundational knowledge and experience, is building higher-level knowledge and skills, and makes independent contributions to projects. ESSENTIAL RESPONSIBILITIES Load and maintain group information and benefit files. Interact and provide support activities to Account Managers (For UCD: Accounts Support Analysts are account managers for all small...

Company : enGen Job Description : JOB SUMMARY We are seeking a hands-on Principal Data Architect to serve as a leader in our ongoing data and digital transformation, leveraging a modern open data ecosystem build on foundational iceberg lakehouse patterns for both humans and AI to thrive. This role will own defining and delivering our enterprise strategy and architectural approach towards data movement [including integration and interoperability], Enrichment, and Orchestration. This scope will span the full enterprise of a complex hybrid ecosystem: We are not a skunkworks team just trying out new technology and you will make our implementations with dbt, airflow, kafka, and iceberg real for a $30B+ company impacting millions of lives across the country. Not only will this person be a leader of our rapid modernization but will insistently keep a business and customer first mentality. The right leader understands the efficiencies and innovations needed to transform...

Company : Highmark Inc. Job Description : JOB SUMMARY This job collaborates with internal stakeholder to understand moderate to complex business requirements and processes related client, product, and benefits configuration solutions. Performs standard and custom benefit coding and new client and group installation, translating group and client information into system configuration, including but not limited to client, group, rates, and commissions data. 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 ZELIS/RedCard experience along with reading and interpreting code within the health insurance...

Company : Highmark Inc. Job Description : JOB SUMMARY 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 job collects, validates, analyzes, and organizes data into meaningful computerized reports by manipulating and extracting data to meet customer needs, generates reports through mainframe and/or PC applications by utilizing established applications/programs or developing new applications/programs, develops work plans to meet deadlines, accurately estimating completion dates and communicating report status to customers and management, and resolves business problems related to automated systems and provide data analysis and recommend...