Highmark Health

Security Engineer

• Develop systems and component architectures and APIs that meet the test of time.
• Articulate and evangelize architectural principles reciprocally with engineering, architecture and product teams that ensure system components fit securely, are sustainable, and align with company’s business direction.
• Analyze and recommend novel technologies, architectural solutions (and associated business cases) to the various technology executives across the company which simultaneously optimize value, risk, spend & design footprints.
• Influence enterprise solutions architects and engineers to define, develop, maintain, and communicate the technology and platform strategy, guidelines, and re-usable design patterns to all levels including the Highmark Health executive team.
• Work with external and internal engineering teams to provide continuous architecture and design mentorship/leadership and be a source of support that ensures successful product delivery and operational excellence in production, including leadership and support for application development and change management activities.
• Establish relationships with key architects and executive technology leadership across the enterprise technology organization and collaborate on promoting architectural standard methodologies.
• Collaborate with key internal and external partners such as security, developers, development managers, product and program management and senior technical and business executives to drive the Architecture strategy, reference enterprise architecture documents, functional specifications, designs, and architectural libraries.
• Resolve approaches for new areas by quickly investigating and synthesizing the state of the art and available technologies including leading the development of enterprise solutions which meet current and future business requirements.
• Take a consultative approach to develop, present and share the value and vision of proposed architectures and solutions to a wide audience.
• Promote architecture standard methodologies and mentor key technical people within the Data Product organization.
• Champion a culture of innovation in an environment that requires high levels of scalability, security and reliability for our most critical enterprise cloud and 'on premise' applications and infrastructure.

Principal Information Security Architect – Data Security

Support Engineer

• Work closely with customers and design teams in prioritizing data and information requirements
• Provide analytic and consultative support to a broad spectrum of internal customer areas and external business partners
• Mentor colleagues with less experience on both the technical and business aspects of project work
• Create and/or develop new methods of analysis, database design and performance measurement
• Perform modeling of data sources and flows
• Develop and maintain moderate-to extremely-complex computer programs using 4GL programming languages (such as SAS, R, SQL)

Lead Decision Support Analyst

Artificial Intelligence

• Define and drive the strategic direction and operational execution of Artificial Intelligence capabilities
• Own the development, communication, and execution of the enGen AI roadmap
• Drive AI adoption and programs within enGen and across the enterprise
• Commercialize enGen's AI capabilities to identify and seed new revenue streams
• Create and nurture strong partnerships across the enterprise and within enGen
• Deliver flexible, high-quality AI solutions and operational frameworks adhering to privacy policies

VP AI Strategy – Enablement

Cloud Engineer

• Transform diverse data sources into actionable intelligence
• Design, build, and optimize scalable data pipelines
• Translate complex engineered data into business-ready insights
• Collaborate with stakeholders to deliver scalable data products

Senior Analytic Data Engineer – Cloud Data Products, Analytic Enablement

Full-stack Engineer

• Building scalable software applications across all digital channels to serve customers.
• Taking an enterprise-wide, architectural view of the solutions and the technical execution of products.
• Responsible for designing and creating engineering specifications for software applications and programs.
• Responsible for designing & writing code that adheres to coding standards.
• Performs code reviews.
• Idea generation and exploring appropriate technical solutions to achieve product features.
• Monitor technical process against project plan while safeguarding functionality, scalability and performance.
• Participate in all scrum ceremonies, assisting in sprint planning and completing required sprints.
• Communicate any issues/blockers to the Scrum Master.
• Drive story creation (i.e. DoD, Acceptance Criteria, estimation).
• Monitor work against production schedule and provide progress updates.

Senior Software Engineer

Manager

• Assures that members with complex medical and/or psychosocial needs have access to high quality, cost-effective health care.
• Assists in the holistic assessment, planning, arranging, coordinating, monitoring, evaluation of outcomes and activities necessary to facilitate member access to healthcare services.
• Advocates for the most appropriate care plan using sound clinical judgment; accurate planning, and collaboration with internal and/or external customers and contacts.
• Follows established regulatory guidelines, policies, and procedures in relation to member interventions and documentation of activities related to the member’s care and progress across the continuum of care.
• Facilitates and/or participates in interdisciplinary and/or interagency meetings, when necessary, to facilitate coordination of services/resources for members.
• Communicate effectively while performing customer telephonic interviewing and communication with external contacts.
• Educate members to enhance member understanding of illness/disease impact and to positively impact member care plan adherence, pharmacy regimen maintenance, and health outcomes.
• Collaborate with Primary Care Physicians, Medical Specialists, Home Health and other ancillary healthcare providers with the goal being to coordinate member care.
• Collect member medical information from a variety of sources including providers and internal records and use appropriate clinical judgment, consultation with internal Physician Advisors and other internal cross-departmental consultation to determine unmet member needs.
• Work primarily independently to identify, define, and resolve a myriad of problem types experienced by the member.
• Develop an individualized plan of care designed to meet the specific needs of each member.
• Anticipate the needs of members by continually assessing and monitoring the member’s progress toward goals, care plan status, and re-adjust goals when indicated.
• Maintain a working knowledge of available resources for addressing identified member needs and to facilitate proactive and efficient provision of services.
• Coordinate with community organizations/agencies for the purpose of identifying additional resources for which the MCO is not responsible.

Medical Case Manager

Product Manager

• Lead the development and evolution of network products
• Define the product's fundamental value proposition and outline execution plans
• Drive the creation of solutions for best-in-class provider networks
• Develop and own the multi-year product strategy
• Define product vision and roadmap
• Oversee product lifecycle from ideation to post-launch optimization
• Provide leadership and mentorship to junior team members
• Communicate product strategy and progress to stakeholders
• Define and track key performance indicators

Senior Product Manager – Network Product

Analyst

• Work with Pharmacy Markets business owners and other management
• Organize and coordinate Pharmacy Markets activities
• Monitor and evaluate progress, status, and alignment of activities
• Perform research on projects and manage and lead projects
• Analyze data to determine business problem, trends, or opportunities
• Partner with business units to ensure compliance with guidelines and regulations
• Collaborate with business owners to understand business needs and develop specifications
• Make decisions that refine and improve practices or develop new approaches

Pharmacy Analyst

Systems Engineer

• Deploy, configure, and manage Linux-based systems
• Ensure robust data protection through CommVault
• Implement and manage backup and restore operations for servers
• Provide first-line technical assistance for Linux and CommVault-related issues
• Develop and utilize scripts (e.g., Python, Bash) to streamline routine tasks
• Collaborate with IT professionals, vendors, and other departments to ensure operational continuity

Linux/CommVault Systems Engineer – Associate/Entry-Level

Actuary

• Initiates and leads the development of actuarial studies and analyses
• Gives direction to less experienced staff
• Applies actuarial techniques and statistical analysis to several functions
• Review the appropriateness of the results in light of experience and industry knowledge
• Initiate and lead the development of studies, analyses, and presentation materials

Underwriter

• Responsible for underwriting new and renewal business within an assigned block
• Use rating manual, experience module and clinical expertise to create pricing that drives P/L, renewal metrics and new business sales for assigned block
• Collaborate with Sales, Underwriting and Clinical to develop and implement pricing actions that will help HMIG meet financial targets
• Train, coach and provide experiences to lower level staff with the purpose of expanding consultative best practices throughout the department
• Utilize client and market knowledge to expand/enhanced Underwriting Guidelines, processes and tools by incorporating best practices
• Monitor overall block performance and report on emerging financial trends
• Develop strategies and tactics to move case level and block results to meet targets
• Act as subject matter expert to support Sales' negotiations to renew existing clients and enroll new business

Medical Stop Loss Underwriting Consultant

General

• Maintains visual observation at all times, monitoring patient behavior and movements utilizing patient monitoring software.
• Recognizes behaviors that could result in potential harm to the patients and verbally redirects them over digital audio devices that is in patient room.
• Immediately communicates needs to the nursing staff based on patient needs and assistance.
• Communicates with internal/external customers/colleagues in a courteous, positive, empathetic and professional manner.
• Provides shift-to-shift hand off to virtual monitoring attendants and nursing staff of pertinent information/behaviors.
• Provides floor staff with information in a timely fashion when patient appears to pose a threat to themselves or others.
• Participates in a collaborative identification and reporting of patient safety issues.
• Assures patient environment safety.
• Identifies potential safety hazards within the room and communicates with the hospital staff for immediate intervention.
• Provides patient with explanations as necessary but does not counsel or provide opinions while maintaining patient's dignity and privacy.
• Demonstrates safe work practice and attitude, follows safety rules, works to prevent unsafe conditions and behaviors, and participates in organizational and department safety programs.

Virtual Patient Monitor

• Implement effective utilization management strategies including review of appropriateness of health care services
• Monitor and analyze the delivery of health care services
• Educate providers and members on a proactive basis
• Develop and sustain positive working relationships with internal and external customers

Care Manager RN – Utilization Management

Medical Billing and Coding

• Performs HCC coding on projects for MA, ACA, and End Stage Renal Disease (ESRD)
• Works independently in various coding applications
• Adheres to CMS Guidelines for Coding and Highmark’s Policy and Procedures
• Maintains RPM coding accuracy and productivity requirements
• Assists with Regulatory Audits by performing first coding review

HCC Coding Specialist

• Maintain oversight over specified panel of members by performing ongoing assessment of members’ health management needs
• Create care plans to address members’ identified needs
• Ensure targeted percentage of patient goal achievement
• Ensure all activities are documented and conducted in compliance with applicable requirements