- CVS Health (Woonsocket, RI)
- …Health. If you'd like to join us on that journey, please read on! The Lead Director, Consumer Healthcare Inventory Management will lead a team of 7 ... planning, buying, expediting, and allocation across a multi-billion-dollar portfolio of consumer healthcare categories. Generally, Ld. Directors have line… more
- Highmark Health (Providence, RI)
- …range in health status/severity and clinical needs. The incumbent assesses health management needs of the assigned member panel and utilizing data/analytics in ... the knowledge and skills to help members with anticipatory guidance (symptom management , managing signs/symptoms as a complication of treatment plan. The incumbent… more
- Highmark Health (Providence, RI)
- …**Required** + Bachelor's Degree in Computer Systems Analysis, Data Processing, Healthcare Informatics, Management Information Systems or closely related ... discipline **Substitutions** + None **Preferred** + Master's Degree in Management Information Systems or Healthcare Informatics **LICENSES OR CERTIFICATION**… more
- Highmark Health (Providence, RI)
- …with strategy / management consulting firms or internal strategy groups of healthcare companies **Preferred** + 3 years in the design of complex digital platform ... in a well-defined matrix reporting structure. **ESSENTIAL RESPONSIBILITIES** + Perform management responsibilities to include, but are not limited to: involved in… more
- Highmark Health (Providence, RI)
- …for productivity enhancements, competitive differentiation, and disruptive transformation in healthcare marketing. You will spearhead the integration of AI ... opportunity to be at the forefront of integrating generative AI into healthcare marketing, shaping the future of healthcare experiences. **ESSENTIAL… more
- Highmark Health (Providence, RI)
- …and communicates effectively with all levels of the organization and senior management for the collection, analysis and documentation of information and creative ... proposition that aligns the Organization's products / services with the customers' healthcare strategy. + Apply knowledge of graphic standards, brand requirements to… more
- Highmark Health (Providence, RI)
- …a variety of technology systems, designing solutions or developing applications in healthcare To Include: + 5 years of translating design mockups, prototypes and ... life cycle, including coding standards, unit testing, code reviews, source control management , build processes, testing, and operations + Strong track record in… more
- Highmark Health (Providence, RI)
- …reports, graphs, and charts to timely identify trends and patterns of potential healthcare fraud, waste and abuse. Communicate findings to company management of ... + Maintain current case related information on all applicable case management tracking systems. + Provide investigative support and mentoring to investigative… more
- Highmark Health (Providence, RI)
- …following + 5 - 7 years in the Healthcare Industry + 5 - 7 years in Management + 5 - 7 years in Contract Development + 1 - 3 years in Legal **Preferred** + None ... :** **JOB SUMMARY** This job manages the business process of contract management with internal departments. The incumbent oversees the staff and facilitates the… more
- Highmark Health (Providence, RI)
- …and insights timelines and deliverables within the MEP. Broad stakeholder management including product owners, vendor and industry partners, clinicians, analytic ... **Required** + 5 years work experience, with some exposure to innovation or healthcare related fields, OR + 3 years work experience post graduate degree, with… more
- Highmark Health (Providence, RI)
- …Analyzes associated policies, guidelines, market data to continuously improve risk management and gain appropriate enrollment or manage existing membership. Analyzes ... This is an entry level position, with oversight by Senior Underwriters and/or Management until the individual is acclimated to the Company procedures, policies and… more
- Highmark Health (Providence, RI)
- …/ management consulting firms or internal strategy groups of healthcare and related companies **Preferred** + Experience in Health Insurance operations and ... to other team members; Provide performance input and recommendations to management for development/ training plans. May have supervisory responsibilities on a… more
- Highmark Health (Providence, RI)
- …through the assignment of appropriate ICD-10 diagnosis codes under the direction of management ; may flex between coding projects with different MA, ESRD, or ACA HCC ... coding productivity and quality accuracy metrics set by the management team. May assist with Regulatory Audits by performing...+ 3 years of medical billing/coding, health insurance, and/or healthcare experience **Preferred** + 1 year of HCC risk… more
- Highmark Health (Providence, RI)
- …the patient, and then creates the case (data entry) in Highmark's utilization management system for clinical review. Ensures all accurate information is entered at ... verification of benefit eligibility. Build cases in the utilization management system. + Use knowledge of process and judgement...0 - 1 year of experience working in the Healthcare Industry **Preferred** + 0 - 1 year of… more
- Highmark Health (Providence, RI)
- …are involved. Develops, implements and maintains Revenue Integrity and CDM Management policies, procedures and training materials. (20%) + Collaborates with ... Audit and other Revenue and Finance departments on revenue management initiatives. (10%) + Develops and maintains a Quality...as assigned. QUALIFICATIONS: Minimum + Bachelor's Degree in Business, Healthcare or related field OR six (6) of related… more
- Highmark Health (Providence, RI)
- …and delivers of complex programs that require cross-functional collaboration and management of inter-dependencies between a group of projects and/or related ... activities within the constraint of scope, quality, time and budget. Includes the management of a group of internal exempt and/or matrixed employees and contractors… more
- Highmark Health (Providence, RI)
- …Analyzes associated policies, guidelines, market data to continuously improve risk management and gain appropriate enrollment or manage existing membership. Analyzes ... to account for these situations. + Apply corporate risk management policies and adjust for unusual situations that may...+ Actively pursuing a professional designation related to the healthcare industry and be willing to complete one course… more
- Highmark Health (Providence, RI)
- …new ideas and contribute to the advancement of AI and GenAI in the healthcare technology space. This role requires a professional dedicated to staying on top of ... that the system architecture balances functional, service quality and systems management requirements. + Use appropriate tools, including models of components and… more
- Highmark Health (Providence, RI)
- …**Substitutions** + None **Preferred** + Bachelor's Degree **EXPERIENCE** **Required** + Healthcare experience + Project Management experience **Preferred** + ... location. Work with Pharmacy Markets business owners, stakeholders and other management , as required, to achieve Pharmacy Markets growth objectives. Organize and… more
- Highmark Health (Providence, RI)
- …or more Epic modules. **Preferred** + 3 years of experience in the healthcare industry **SKILLS** + Ability to handle analysis, design, system configuration and ... organizational skills in managing priorities + Demonstrates knowledge of project management principles as they relate to assigned tasks **EDUCATION** **Required** +… more