Highmark Health

Strategy

• Support executive leadership with a range of strategy activities essential to membership and margin goals.
• Provide analytical/strategic-thinking and leadership support to medical policy and utilization management teams.
• Manage major strategy projects with the help of internal or external strategy consulting resources.
• Serve as subject matter expert to Strategic Operations staff on membership, growth and operational strategy issues.
• Develop analytical frameworks and methodology best practices to analyze strategy issues.

Strategy Consultant – Medical Policy

Software Engineer

• Lead the design, development, and implementation of complex systematic solutions
• Analyze customer requirements, design robust architectures, code, test, and deploy solutions
• Maintain complex applications and ensure high service levels and quality standards
• Mentor less experienced team members

Senior Application Developer – Open Systems

Analyst

• Drive the full lifecycle of medical policies, from initial development to publication and maintenance
• Leverage advanced data analytics to generate insights and develop reporting solutions
• Act as a primary owner of assigned medical policies, ensuring accuracy and clinical soundness
• Engage non-clinical teams to align operational guidelines with clinical policy intent
• Serve as a subject matter expert for internal and external customers

Lead Clinical and Population Health Analyst – Medical Policy

Medical Director

• Supports the Medical Policy team with expertise and knowledge
• Full-cycle ownership of commercial and Medicare Advantage medical policies
• Writing clinical criteria based on research
• Engagement of clinical and non-clinical team members for operational guidelines
• Address escalated inquiries from internal/external partners
• Conducts peer reviews as part of the quality review process
• Participates in various work-groups and sub-committees as a clinical lead/expert

Medical Director, Medical Policy

Manager

• Oversee and manage healthcare management analytics in the Medical Policy department.
• Develop and implement complex analytical, research, and decision support activities.
• Consult and provide analytical expertise for various projects related to Medical Policy.
• Manage hiring, coaching, and performance management of staff.
• Ensure timely delivery of all projects and initiatives.
• Establish vision and strategy for the analytics function.
• Stay current with industry best practices and tools in data visualization.

Manager, Healthcare Analytics – Medical Policy

Database Administrator

• Manage the day-to-day operation, maintenance, and performance tuning of on-prem SQL Server instances and databases
• Monitor, capacity plan, and optimize queries
• Install, configure, and patch SQL Server environments
• Maintain backup and recovery strategies to ensure data integrity and availability
• Monitor and maintain existing HA/DR solutions (e.g., Always On Availability Groups)
• Administer SQL Server security, managing logins, users, roles, permissions
• Diagnose and resolve database-related issues
• Maintain clear and comprehensive documentation for database systems and processes