- PulteGroup (Westborough, MA)
- …is a FORTUNE 500 company and one of America's top residential builders. We put the consumer at the center of everything we do and we stand above the competition in ... our commitment to quality.Our Vision is to Build Consumer Inspired Homes & Communities to Make Lives Better and we believe that success starts with having the right… more
- Highmark Health (Providence, RI)
- …job provides telephonic integrated behavioral and physical health case and condition management services to members with mental health, substance use, and co-morbid ... short and long-term health goals. They support members in developing self- management skills and adopting positive behavior change; identify and address gaps… 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)
- …responsible for building relationships, engaging clinicians, educating on Utilization Management policies and processes, developing workflows and resources, and ... **Required** + 5 years experience in any of the following healthcare areas:the provider environment (hospital, facility, PCP, specialist, supporting area(s)), or… 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)
- … Healthcare or related field **EXPERIENCE** **Required** + 3 years of Digital Product Management + 2 years in the Healthcare Industry **Preferred** + 3 years ... of new technologies, market trends, and vendor capabilities. References the inventory of existing digital capabilities and determines whether they can solve… more
- Highmark Health (Providence, RI)
- …**Minimum** + Bachelor's Degree in Clinical-related field, Business Administration, Healthcare Administration, Health Information Management , or related ... **Preferred** + Bachelor's Degree - Clinical-related field, Business Administration, Healthcare Administration, Health Information Management , or related field… 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)
- …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