Qureos Mentor

Highmark Health

<div><h2 class="jobSectionHeader">Company :
</h2>Highmark Inc.
<h2 class="jobSectionHeader">Job Description :
</h2>JOB SUMMARY 
 
This job works closely with customers and design teams in prioritizing data and information requirements. This job provides analysis in the development and support of projects and data analysis. Determines how decision support systems will provide information required to make effective business decisions; translates requirements into applications that employ appropriate decision support and reporting tools. Recommends innovative approaches to analytical investigations. Performs modeling of data sources and flows, works with data management staff to define an operational framework that will define, develop and implement policies and security frameworks to ensure precise and secure delivery of knowledge and information.
The day to day responsibilities:
<ul><li>Support QC Analysts with data needs, report development, scheduled reports and ad-hoc reporting requests
</li><li>Identifies data discrepancies across multiple operational systems
</li><li>Builds data models across Salesforce, operations and billing systems to ensure billing accuracy and completeness
</li><li>Creates monthly metrics and visualization files to gauge operational performance
</li></ul>ESSENTIAL RESPONSIBILITIES
<ul><li>Develop and foster internal relationships across the corporation. Provide analytic and consultative support to a broad spectrum of internal customer areas and external business partners.
</li><li>Mentor colleagues with less experience on both the technical and business aspects of project and consultative work.
</li><li>Determine how decision support systems will provide information required to make effective business decisions, translate requirements into applications that employ appropriate decision support and reporting tools. Use broad experience and technical knowledge to propose solutions to complex business problems. Take the lead in driving the implementation of the recommended solutions.
</li><li>Take the lead in defining issues and ideas to be studied as well as the approach (methodological and technical) to be used in addressing studies and projects. Create and/or develop new methods of analysis, database design, and performance measurement or, in some cases, adaptation of existing solutions to new areas.
</li><li>Perform modeling of data sources and flows, work with data management staff to define an operational framework that will define, develop, and implement policies and security frameworks to ensure precise and secure deliver of knowledge and information.
</li><li>Provide assistance and, depending on skill and experience, lead with interpretation of raw data, statistical results or otherwise compiled information, identify follow-up action items, and prepare or assist in the preparation of written reports and/or oral presentation of findings to internal and external audiences, customer managers, clinical staff, compliance agencies, group accounts, providers, agent plans, and brokers.
</li><li>Develop and maintain moderate-to extremely-complex computer programs using 4GL programming languages (such as SAS, R, SQL) and other database technology (DB2, Teradata, and Oracle).
</li><li>Other duties as assigned or requested.
</li></ul>EDUCATION
Required
<ul><li>Bachelor's Degree in Computer/Information Science, Mathematics/Statistics, Economics, Industrial Engineering or Operations Research, or related field
</li></ul>Substitutions
<ul><li>None
</li></ul>Preferred
<ul><li>Master's degree in or related to Computer/Information Science, Mathematics/Statistics, Economics, Industrial Engineering or Operations Research
</li></ul>EXPERIENCE
Required
<ul><li>5 years of relevant, progressive experience as a Decision Support Analyst or equivalent training and experience in a business or clinical environment with direct responsibility for applying technology
</li></ul>Preferred
<ul><li>None
</li></ul>SKILLS
<ul><li>Strong technical skills in the mainframe, PC and Internet-based technologies to be effective and must be comfortable and proficient using large and complex databases
</li><li>Strong skills using various third-party office and report generation products such as Microsoft Office, Business Objects, Cognos, and Enterprise Guide.
</li><li>Strong communication skills. Must be comfortable presenting findings and offering recommendations to senior management
</li></ul>Preferred Skills:
<ul><li>Experience building in Dataiku, Alteryx, or similar data transformation tools
</li><li>Experience with Python or other high-level programming languages
</li><li>Experience in data warehousing and pipelines using BigQuery and GCS storage solutions
</li></ul>Language (Other than English):
None
Travel Requirement:
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office-based
Teaches / trains others regularly
Never
Travel regularly from the office to various work sites or from site-to-site
Never
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Never
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
 
 
Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
 
 
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company&rsquo;s Handbook of Privacy Policies and Practices and Information Security Policy.
 
 
Furthermore, it is every employee&rsquo;s responsibility to comply with the company&rsquo;s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and traini
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org
California Consumer Privacy Act Employees, Contractors, and Applicants Notice</div>

Senior Decision Support Analyst

<div><h2 class="jobSectionHeader">Company :
</h2>Highmark Health
<h2 class="jobSectionHeader">Job Description :
</h2>JOB SUMMARY
This role serves as a dedicated strategic partner to the Senior Director of Case Management Product, focusing specifically on the strategic alignment, growth, and optimization of both the Case Management program portfolio and the Case Management platform &amp; capabilities portfolio. The incumbent will translate overarching enterprise strategy into actionable product and program strategies for Case Management, ensuring strong linkages between technical capabilities, operational execution, and business outcomes. This includes deep dives into market opportunities, leveraging internal expertise to inform strategic direction for our CM offerings, and identifying strategic pathways for innovation and efficiency within our clinical operations and supporting technology. A key responsibility will be to synthesize complex strategic insights, business cases, and portfolio roadmaps into compelling, executive-level presentations and communications that clearly articulate the value, strategic rationale, and desired outcomes for our Case Management initiatives.
This job supports the executive leadership of the Organization with a range of strategy activities essential to ensuring the Organization's goals. Provide analytical/strategic thinking and leadership support that enables project teams to isolate business issues, design and execute analytics for studying business issues (market research, scenario planning, forecasting, market share, profitability, etc.), develop technical content (competitive intelligence, market trend analysis), support development of formal recommendations to senior levels of organizational leadership, create documents (go-to-market or operational strategies, etc.) that inform critical strategic issues and decisions, support the planning, communication, and management of the enterprise strategy, and/or support the execution of enterprise strategic initiatives through a disciplined process and approach.
ESSENTIAL RESPONSIBILITIES
<ul><li>Work with business/market owners to identify key business issues, apply right analytical framework, develop solution and recommendations, represent findings to stakeholders, and own the outcome.
</li><li>Manage major strategy projects comprised of internal and/or external consulting resources.
</li><li>Provide periodic informal work guidance/direction to junior team members; provide performance input and recommendations to management for development/training plans. May have supervisory responsibilities on a project basis.
</li><li>Develop analytical frameworks, approach, and methodology best practices to analyze strategy issues.
</li><li>Consult with business owners to identify, clarify, and resolve complex issues critical to the success of the initiative.
</li><li>Coordinate initiative impacts with other strategic initiatives to ensure alignment of the overall strategy.
</li><li>Work on other Enterprise level strategy projects as needed.
</li><li>Other duties as assigned or requested.
</li></ul>EDUCATION
Required
<ul><li>Bachelor's Degree in Business, or related field, or relevant experience and/or education as determined by the company in lieu of bachelor's degree.
</li></ul>Preferred
<ul><li>Master&rsquo;s Degree in Business, or related field
</li></ul>EXPERIENCE 
 
Required
<ul><li>7 years of experience in strategic planning or related work experience
</li><li>2 years of consulting experience (external or internal) or equivalent combination of experience and advanced degree
</li></ul>Preferred
<ul><li>Experience in developing product or portfolio-level strategies, roadmaps, and business cases.
</li><li>Proven experience in preparing and delivering executive-level presentations, strategic narratives, and white papers that drive decision-making.
</li><li>Extensive knowledge of health insurance and/or provider operations
</li><li>Experience in operational improvement, change management, capability roadmaps, and/or program management
</li><li>Thorough knowledge of membership, rates, financial, economic, and competitive data
</li><li>Significant experience working across teams and managing relationships in a matrixed environment
</li><li>Experience working with health plans, physicians, and other providers
</li><li>Support the planning, communication, and management of the enterprise strategy
</li><li>Direct experience with Case Management, Care Management, or clinical operations.
</li><li>Experience working closely with product management and/or engineering teams to define and prioritize strategic initiatives.
</li><li>Familiarity with technology trends and their application in healthcare, especially related to workflow automation, data analytics, and digital health within clinical programs.
</li><li>Demonstrated success in identifying strategic growth opportunities and designing initiatives to capture them, with a focus on value creation for both members and the organization.
</li></ul>SKILLS
<ul><li>Understanding of the health care industry trends and challenges
</li><li>Demonstrated relationship, influencing, collaboration, and teamwork skills. Needs to be able to lead cross-functional, cross- business unit teams in complex projects and handle internal politics of change
</li><li>Strong project leadership/management skills
</li><li>Strong emotional intelligence, with servant leadership mindset
</li><li>Focus on impacts to the customer of decisions rendered
</li><li>Proactive in driving change and continuous improvement
</li><li>Team management skills
</li><li>Deep analytical skills, with the ability to structure and perform complex analytics
</li><li>Demonstrated ability to synthesize complex information from diverse sources (e.g., market data, operational metrics, clinical outcomes, technical capabilities) into clear, concise strategic recommendations.
</li><li>Exceptional storytelling and presentation skills, with a track record of developing and delivering impactful communications to senior executive audiences.
</li></ul>Language (Other than English):
<ul><li>None
</li></ul>Travel Requirement:
<ul><li>0% - 25%
</li></ul>PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
<ul><li>Office-based
</li></ul>Teaches / trains others regularly
<ul><li>Occasionally
</li></ul>Travel regularly from the office to various work sites or from site-to-site
<ul><li>Rarely
</li></ul>Works primarily out-of-the office selling products/services (sales employees)
<ul><li>Never
</li></ul>Physical work site required
<ul><li>Yes
</li></ul>Lifting: up to 10 pounds
<ul><li>Constantly
</li></ul>Lifting: 10 to 25 pounds
<ul><li>Occasionally
</li></ul>Lifting: 25 to 50 pounds
<ul><li>Never
</li></ul>Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
 
 
Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
 
 
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company&rsquo;s Handbook of Privacy Policies and Practices and Information Security Policy.
 
 
Furthermore, it is every employee&rsquo;s responsibility to comply with the company&rsquo;s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org
California Consumer Privacy Act Employees, Contractors, and Applicants Notice</div>

Senior Strategy Partner - Case Management Product Portfolio

<div><h2 class="jobSectionHeader">Company :
</h2>Highmark Health
<h2 class="jobSectionHeader">Job Description :
</h2>JOB SUMMARY
This job is part of an executive administrative team. This job provides administrative support to more than one Vice President and/or Senior Vice President. Incumbents will rely on experience and judgment to complete responsibilities, plan, accomplish goals and meet deadlines, and is required to be a consummate professional with a demonstrated record of enabling executives to carry out their duties with high effectiveness and efficiency. This job will have latitude in work project and requires a highly self-motivated with strong work ethic, diplomacy, political awareness, multi-tasking capabilities and the ability to execute their work by prioritizing tasks in a fast-paced environment.
This is a hybrid based role in Wilkes Barre, PA - onsite 3 days a week - T, W, TH. 
 
ESSENTIAL RESPONSIBILITIES
<ul><li>Communicate effectively both in person and virtually to all levels in the organization. Display effective communication skills while interacting and responding, both written and verbally, with internal and external entities on behalf of assigned management. Maintain a communication flow by receiving and distributing correspondence via mail services or on-line communication networks.
</li><li>Provide secretarial services support to assigned Executives (Vice President and above). Responsibilities include, but are not limited to: (a) maintaining calendars for the Executive including scheduling meetings, making conference room reservations, meeting arrangements, and arranging audio/visual equipment as needed. Prepare for meetings by creating, organizing, and distributing meeting materials; (b) performing typing, word processing, transcribing and proofreading activities concerning correspondence, memoranda, schedules, reports, presentation materials and statistical information; (c) using Microsoft products to create and revise files including but not limited to spreadsheets and executive presentations; (d) attending selected meetings in a non-participatory manner to take appropriate notes and conserve time while assuring familiarity with meeting developments; (e) Scheduling travel and managing the executive&rsquo;s itinerary, and processing expenses for reimbursement; (f) compiling various information and performing minor calculations as required for departmental reports; (g) Maintain a communication flow by receiving and distributing correspondence via mail services or on-line communication networks; (h) Scheduling reservations, meeting arrangements, conference rooms and audio/visual equipment as needed; (i) Receiving visitors and telephone calls in a courteous and efficient manner and direct inquires to the appropriate staff based on an overall knowledge of departmental policies and procedures and/or (j) Maintaining hardcopy and on-line correspondence and administrative files.
</li><li>Serves as the point of contact for department organization by working with the Executive to schedule and organize team events, coordinate new employee onboarding, and ensure the team has access to necessary supplies. Works with IT for technology and system requests as needed.
</li><li>Works closely and effectively with the executive to keep him/her well informed of upcoming commitments and responsibilities; following up appropriately.
</li><li>Review and prioritize information and inquiries received for the consideration of the Executives, make high-level contacts from both inside and outside the Organization, and address and answer inquiries and solicitations paying constant attention to formal clearance, procedural controls, and organizational sensitivity.
</li>Other duties as assigned or requested. 
<li>
</li></ul> 
EDUCATION 
 
Required
High School / GED 
<ul><li>
</li></ul> 
Substitutions
None 
<ul><li>
</li></ul> 
Preferred
<ul><li>Associate's Degree OR
</li>Bachelor's Degree 
<li>
</li></ul> 
EXPERIENCE 
 
Required
<ul><li>5 years in a secretarial, administrative or executive assistant role
</li></ul>To Include
3 years with Microsoft Office, Outlook, Word, Excel, PowerPoint and Adobe Acrobat 
<ul><li>
</li></ul> 
Preferred
<ul><li>None
</li></ul>LICENSES or CERTIFICATIONS 
 
Required
<ul><li>None
</li></ul>Preferred
<ul><li>None
</li></ul>SKILLS
<ul><li>Excellent typing, word processing and/or typing and proofreading skills as well as a working knowledge of PC word processing, spreadsheet and graphic applications
</li><li>Organizational Skills
</li><li>Possess the utmost of integrity in the discreet handling of confidential information
</li><li>Knowledge of corporate programs, policies, procedures and protocols
</li>Effective verbal and written communication skills 
<li>
</li></ul> 
Language (Other than English):
None
Travel Requirement:
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office-based
Teaches / trains others regularly
Rarely
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Rarely
Lifting: 25 to 50 pounds
Rarely
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
 
 
Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
 
 
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company&rsquo;s Handbook of Privacy Policies and Practices and Information Security Policy.
 
 
Furthermore, it is every employee&rsquo;s responsibility to comply with the company&rsquo;s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org
California Consumer Privacy Act Employees, Contractors, and Applicants Notice</div>

Executive Assistant - Senior and Vice President Pool

<div><h2 class="jobSectionHeader">Company :
</h2>Highmark Health
<h2 class="jobSectionHeader">Job Description :
</h2>JOB SUMMARY
This job is part of an executive administrative team. This job provides administrative support to more than one Vice President and/or Senior Vice President. Incumbents will rely on experience and judgment to complete responsibilities, plan, accomplish goals and meet deadlines, and is required to be a consummate professional with a demonstrated record of enabling executives to carry out their duties with high effectiveness and efficiency. This job will have latitude in work project and requires a highly self-motivated with strong work ethic, diplomacy, political awareness, multi-tasking capabilities and the ability to execute their work by prioritizing tasks in a fast-paced environment.
This is a hybrid based role in Pittsburgh, PA - Onsite 3 days a week - T, W, TH. 
 
ESSENTIAL RESPONSIBILITIES
<ul><li>Communicate effectively both in person and virtually to all levels in the organization. Display effective communication skills while interacting and responding, both written and verbally, with internal and external entities on behalf of assigned management. Maintain a communication flow by receiving and distributing correspondence via mail services or on-line communication networks.
</li><li>Provide secretarial services support to assigned Executives (Vice President and above). Responsibilities include, but are not limited to: (a) maintaining calendars for the Executive including scheduling meetings, making conference room reservations, meeting arrangements, and arranging audio/visual equipment as needed. Prepare for meetings by creating, organizing, and distributing meeting materials; (b) performing typing, word processing, transcribing and proofreading activities concerning correspondence, memoranda, schedules, reports, presentation materials and statistical information; (c) using Microsoft products to create and revise files including but not limited to spreadsheets and executive presentations; (d) attending selected meetings in a non-participatory manner to take appropriate notes and conserve time while assuring familiarity with meeting developments; (e) Scheduling travel and managing the executive&rsquo;s itinerary, and processing expenses for reimbursement; (f) compiling various information and performing minor calculations as required for departmental reports; (g) Maintain a communication flow by receiving and distributing correspondence via mail services or on-line communication networks; (h) Scheduling reservations, meeting arrangements, conference rooms and audio/visual equipment as needed; (i) Receiving visitors and telephone calls in a courteous and efficient manner and direct inquires to the appropriate staff based on an overall knowledge of departmental policies and procedures and/or (j) Maintaining hardcopy and on-line correspondence and administrative files.
</li><li>Serves as the point of contact for department organization by working with the Executive to schedule and organize team events, coordinate new employee onboarding, and ensure the team has access to necessary supplies. Works with IT for technology and system requests as needed.
</li><li>Works closely and effectively with the executive to keep him/her well informed of upcoming commitments and responsibilities; following up appropriately.
</li><li>Review and prioritize information and inquiries received for the consideration of the Executives, make high-level contacts from both inside and outside the Organization, and address and answer inquiries and solicitations paying constant attention to formal clearance, procedural controls, and organizational sensitivity.
</li>Other duties as assigned or requested. 
<li>
</li></ul> 
EDUCATION 
 
Required
High School / GED 
<ul><li>
</li></ul> 
Substitutions
None 
<ul><li>
</li></ul> 
Preferred
<ul><li>Associate's Degree OR
</li>Bachelor's Degree 
<li>
</li></ul> 
EXPERIENCE 
 
Required
<ul><li>5 years in a secretarial, administrative or executive assistant role
</li></ul>To Include
3 years with Microsoft Office, Outlook, Word, Excel, PowerPoint and Adobe Acrobat 
<ul><li>
</li></ul> 
Preferred
<ul><li>None
</li></ul>LICENSES or CERTIFICATIONS 
 
Required
<ul><li>None
</li></ul>Preferred
<ul><li>None
</li></ul>SKILLS
<ul><li>Excellent typing, word processing and/or typing and proofreading skills as well as a working knowledge of PC word processing, spreadsheet and graphic applications
</li><li>Organizational Skills
</li><li>Possess the utmost of integrity in the discreet handling of confidential information
</li><li>Knowledge of corporate programs, policies, procedures and protocols
</li>Effective verbal and written communication skills 
<li>
</li></ul> 
Language (Other than English):
None
Travel Requirement:
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office-based
Teaches / trains others regularly
Rarely
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Rarely
Lifting: 25 to 50 pounds
Rarely
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
 
 
Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
 
 
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company&rsquo;s Handbook of Privacy Policies and Practices and Information Security Policy.
 
 
Furthermore, it is every employee&rsquo;s responsibility to comply with the company&rsquo;s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org
California Consumer Privacy Act Employees, Contractors, and Applicants Notice</div>

Executive Assistant - Senior and Vice President Pool - Legal

<div><h2 class="jobSectionHeader">Company :
</h2>Highmark Health
<h2 class="jobSectionHeader">Job Description :
</h2>JOB SUMMARY
This job is responsible for the successful definition, implementation and delivery of complex programs that requires cross-functional collaboration and interdependencies between a group of projects and/or related activities within the constraint of scope, quality, time, and budget and under circumstances involving moderate to high-impact risk factors, in a cyber security portfolio, strategy and delivery environment. Works collaboratively with a diverse group of team members and contractors across multiple project teams or departmental work groups, ensuring their efforts align to deliver unified, coordinated results. They will develop and guide the implementation of project or program roadmaps for cybersecurity-related products and technology applications, ensuring that approved business outcomes are delivered effectively. Additionally, they may be asked to supervise both the rollout and ongoing management of cybersecurity programs across multiple tenants, coordinating efforts to achieve seamless integration and sustained operational success. While there is no direct management of staffing, collaboration is emphasized to ensure the appropriate team members are fully engaged in the process to ensure approved business outcomes are delivered at lowest cost and maximized profitability. They may be asked to prepare and share comprehensive, data-driven impact analyses that address both quality and risk across cybersecurity catalogue of services. To ensure lasting results, they will apply change management strategies and actively promote positive security behaviors throughout the implementation process, supporting sustainability and ongoing improvement. Oversee a range of activities focused on gathering, analyzing, and presenting key performance indicators by creating dashboards and scorecards, conducting forecasting and trend analysis, tracking outcomes, and preparing executive-level presentations. This comprehensive approach ensures that relevant performance data is systematically collected and interpreted, enabling informed decision-making and continuous improvement across the organization.
ESSENTIAL RESPONSIBILITIES
<ul><li>Cross-functional collaboration and interdependency management between a group of projects, products/technologies, functions, and/or customers.
</li><li>Ensure clear lines of communication including but not limited to; transparency to the business on upcoming security initiatives, identifying impact to the business and to consumers, helping shape remediation, and developing external and internal communications
</li><li>Responsible for establishing and driving Information Security programs designed for the business to improve security behaviors.
</li><li>Measure program effectiveness and report accordingly on progress through approved business KPIs and outcomes.
</li><li>Utilize change management methodologies to mitigate identified security risks.
</li><li>Understand and bring to life, the role of cyber governance and how it supports the overall mission of program delivery
</li><li>Bring a risk-management approach to programs and projects governed ensuring cyber risks are managed and mitigated through our defined processes
</li><li>Must have a foundational understanding of portfolio management and governance methods, including portfolio financial management.
</li><li>Demonstrate a commitment to independent learning and possess a proactive mindset, showing the initiative and motivation necessary to successfully fulfill all job responsibilities.
</li><li>Other duties as assigned or requested.
</li></ul>EDUCATION
Required
<ul><li>Bachelor's Degree in Business Education, Marketing or Information Systems
</li></ul>Substitutions
<ul><li>Six (6) years relevant, progressive experience
</li></ul>Preferred
<ul><li>Master's Degree in Business Administration or Business Management
</li></ul>EXPERIENCE
Required
<ul><li>5 years in IS/IT or IT Security
</li></ul>Preferred
<ul><li>Minimum of 3 years of Project Management or Program Management
</li></ul>LICENSES or CERTIFICATIONS
Required
<ul><li>None
</li></ul>Preferred (any combination)
<ul><li>PMP, SAFe , or CSM (certified scrum master)
</li><li>Cyber or IT related certifications (examples, CISSP, ITIL)
</li><li>Risk Management related (ie., NIST)
</li><li>Change Management, Prosci or similar
</li></ul>SKILLS
<ul><li>Program and Project Delivery in Cyber/IT Environments: Demonstrates expertise in managing the full lifecycle of programs and projects within cybersecurity and IT settings, ensuring objectives are consistently met.
</li><li>Change Management: Demonstrated ability to guide organizations through transitions, implementing strategies that ensure lasting improvements and adaptability.
</li><li>Prioritizing: Skilled at identifying critical tasks and organizing work to maximize efficiency and impact, even in complex and fast-paced environments.
</li><li>Analytical and Logical Reasoning: Possesses strong analytical thinking, enabling them to dissect problems, evaluate solutions, and make informed decisions rooted in logic and data.
</li><li>Risk Mitigation Planning and Remediation: Experienced in developing comprehensive strategies to identify, assess, and address risks, ensuring that potential issues are proactively managed and resolved.
</li><li>Financial Management in Portfolio Governance: Proficient in overseeing financial aspects within a portfolio governance framework, ensuring resources are allocated effectively to support organizational objectives.
</li><li>Communication Skills: Adept at delivering executive-level presentations and facilitating clear, persuasive communication across diverse audiences.
</li><li>Conflict Resolution: Brings proven experience in navigating and resolving conflicts, fostering collaboration, and maintaining productive working relationships.
</li></ul>Language (Other than English):
None
Travel Requirement:
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Remote or Office-based
Teaches / trains others regularly
Frequently
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
No
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
 
 
Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
 
 
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company&rsquo;s Handbook of Privacy Policies and Practices and Information Security Policy.
 
 
Furthermore, it is every employee&rsquo;s responsibility to comply with the company&rsquo;s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org
California Consumer Privacy Act Employees, Contractors, and Applicants Notice</div>

Program Manager - ISRM

<div><h2 class="jobSectionHeader">Company :
</h2>Highmark Inc.
<h2 class="jobSectionHeader">Job Description :
</h2>JOB SUMMARY
This job is responsible for using medical cost analytics to provide fact based strategic insights into emerging medical cost trends. Using large sets of data, the ideal candidate will create the story of medical cost trends in a way that is clear, concise and easily understandable. The incumbent will have proven detailed technical and analytical experience with strong communication and influencing skills. More specifically, will engage with matrix partners to develop the medical cost analytics to determine the value of business solutions. Using data driven analytics, the ideal candidate will: 1) develop the value of the programs, 2) track the outcomes of the programs, and 3) provide strategic insight into areas of focus/opportunities.
This is a hybrid based role in Pittsburgh, PA. You will be required to be onsite 3 days a week. T, W, Th. The ideal candidate for this role will have medical and pharmacy claims data experience.
ESSENTIAL RESPONSIBILITIES
<ul><li>Provide strategic/tactical insights into emerging medical cost trends. Develop executive ready presentations explaining analytical findings in a clear concise manner.
</li><li>Proficiency to extract, summarize and analyze large datasets via SAS, SQL or other similar tools.
</li><li>Provide business areas with opportunity assessments of their strategic medical cost programs. Coordinate savings opportunity projections and post implementation savings measurements. Develop improved business case and savings estimate capabilities to enable more accurate and deeper projections.
</li><li>Leverage analytical experience and knowledge to drive independent medical cost analytics; develop areas of opportunity using a fact-based analysis, present medical cost analytics and insight into claim cost drivers to key business partners.
</li><li>Strong communication skills (verbal and executive quality presentations) to present clear, concise presentations of the detailed analytics.
</li><li>Work in a matrixed work environment. Partner with other departments in developing the full analytical story.
</li><li>Other duties as assigned or requested.
</li></ul>EDUCATION
Required
<ul><li>Bachelor's Degree in Business, Health, Economics, Mathematics/Actuarial Sciences or other related area
</li></ul>Substitutions
<ul><li>None
</li></ul>Preferred
<ul><li>Master's Degree in Business, Health, Economics, Mathematics/Actuarial Sciences or other related area
</li></ul>EXPERIENCE
Required
<ul><li>5 years of Medical Economics, Healthcare Analytics, Informatics and/or Actuarial Services in the health care payer sector
</li></ul>Preferred
<ul><li>None
</li></ul>LICENSES AND CERTIFICATIONS
Required
<ul><li>None
</li></ul>Preferred
<ul><li>None
</li></ul>SKILLS
<ul><li>Proven analytical ability to drive independent work and meet business timelines and outcomes.
</li><li>Strong Technical Data Skills (SAS / SQL, R, Tableau, Excel, etc.)
</li><li>Demonstrated ability to work with business partners in communicating outcomes, partnering on analytics, and developing new approaches to breaking down a strategic hypothesis.
</li><li>Experience in the healthcare Industry, with solid knowledge of emerging trends and challenges
</li></ul>Languages (Other then English)
None
Travel Required
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office-Based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
 Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Rarely
Lifting: 25 to 50 pounds
Never
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company&rsquo;s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee&rsquo;s responsibility to comply with the company&rsquo;s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org
California Consumer Privacy Act Employees, Contractors, and Applicants Notice</div>

Medical Economics Consultant - Medicaid Segment C2V

<div><h2 class="jobSectionHeader">Company :
</h2>Highmark Inc.
<h2 class="jobSectionHeader">Job Description :
</h2>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. The incumbent is responsible for renewing accounts and selling new products and services to existing accounts to ensure retention and growth of profitable business. The incumbent is responsible for complex accounts that are multi-state and non-standard and complex, involving multiple, custom products and benefit designs. 
 
ESSENTIAL RESPONSIBILITIES
<ul><li>Client Relationship Management &amp; Strategy: Manage and cultivate strategic relationships at senior levels with clients, consultants, and brokers/producers to foster valued business partnerships, demonstrate business acumen, and maintain an active network. Serve as the primary pharmacy client contact for strategic planning, consultation, and ongoing account management, overseeing a book of business for complex, multi-state, and non-standard accounts. Proactively engage clients to understand evolving needs, business plans, and financial objectives, driving client retention and satisfaction by ensuring continuous alignment with Highmark&rsquo;s pharmacy benefit solutions.
</li><li>Sales, Growth &amp; Financial Acumen: Review and present new products, services, capabilities, and technologies to sell assigned product lines, secure pharmacy renewals, and achieve add-on sales to ensure retention, profitability, and growth of existing business. Analyze customer needs and organizational financial objectives to recommend appropriate pharmacy benefit products and services, including formulary management, clinical programs, specialty pharmacy, and network management, offering specific benefit alternatives and financial arrangements. Develop, implement, and execute comprehensive business plans and metrics for retaining and growing membership while enhancing profitability and cross-selling. Complete and maintain accurate sales projections, finalize rates and benefit adjustments, and prepare compelling reports and documents for renewal and sales presentations. Develop appropriate sales solutions considering increased competition and the changing political and regulatory environment.
</li><li>Operational Oversight &amp; Issue Resolution: Coordinate all post-sale and ongoing operational aspects of the company's services, communicating effectively with senior-level client executives, legal, internal departments, and external vendors. Support customers during the implementation of sales contracts and throughout the relationship by advocating for and resolving escalated pharmacy service issues in a timely and professional manner, taking responsibility for customer satisfaction and loyalty. Manage customer activity efficiently using CRM tools for maximum visibility, meticulously following up to close open issues, and providing regular updates and insights to management on client health and retention strategies.
</li><li>Product Development &amp; Market Leadership: Participate in product development and prepare business programs (e.g., territory-specific action plans and sales strategies) and long-term strategies for specific account needs, providing client-centric feedback to ensure offerings remain competitive and meet market demands. Lead internal partners (e.g., Clinical, Analytics, Product ) in delivering comprehensive client strategies and solutions. Adapt procedures and processes to meet the complex requirements of key accounts, providing direction to other incumbents as needed. Serve as a market leader on key projects and initiatives, solving complex problems by taking a broad perspective and developing innovative solutions.
</li><li>Pharmacy Benefit Expertise: Leverage expertise in pharmacy pricing and contract details to effectively consult with clients on repricing proposals and benefit design optimizations. Stay up-to-date on industry trends, regulatory changes, and competitive developments within the pharmacy benefits landscape. Analyze client data and trends to identify potential retention risks and develop proactive strategies to mitigate them.
</li><li>Other duties as assigned or requested.
</li></ul>EXPERIENCE
Required
<ul><li>5 years of experience with Client Manager or Consultant role or client-facing role focused on account management, client retention, or sales within the healthcare or pharmacy benefits industry. 
</li></ul> 
Preferred
<ul><li>None
</li></ul>SKILLS
<ul><li>Possess and applies broad and in-depth knowledge of the concepts, principles, practices and processes of the specific market
</li><li>Ability to speak publicly and extemporaneously on a variety of subjects
</li><li>Presentation, communication and negotiation skills
</li><li>Organizational skills and the ability to meet deadlines
</li><li>Creativity and Innovation
</li><li>Persistence &amp; Resilience
</li><li>Problem Solving &amp; Influence
</li><li>Analytical and Logical and Strategic Reasoning/Thinking
</li><li>Decision Making
</li><li>Microsoft Office (Excel &amp; Word)
</li></ul>EDUCATION
Required
<ul><li>Bachelor&rsquo;s degree in Bachelors Business Administration/Management, Pharmacy or Science related field.
</li></ul>Substitutions
<ul><li>6 years Pharmacy programs/sales experience in lieu of Bachelor degree. 
</li></ul> 
Preferred
<ul><li>Masters in MBA, BSN
</li><li>Doctorate in MBA, BSN, Pharm D 
</li></ul> 
LICENSES or CERTIFICATIONS
Required
<ul><li>State specific producer license Life, Accident, &amp; Health must be obtained within 45 days of hire 
</li></ul> 
Preferred
<ul><li>Pharmacist license, Nursing License, Any project management or Six Sigma certifications.
</li><li>Certified Pharmacy Technician Licenses 
</li></ul> 
Language (Other than English):
<ul><li>None
</li></ul>Travel Required:
<ul><li>Frequently
</li></ul>PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
<ul><li>Office-Based or Remote Position
</li></ul>Physical work site required
<ul><li>25% - 50%
</li></ul>Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
 
 
Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
 
 
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company&rsquo;s Handbook of Privacy Policies and Practices and Information Security Policy.
 
 
Furthermore, it is every employee&rsquo;s responsibility to comply with the company&rsquo;s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org
California Consumer Privacy Act Employees, Contractors, and Applicants Notice</div>

Pharmacy Strategic Account Executive

Join Highmark Health and explore 10   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.