Top 32 Highmark health remote Jobs

Associate Care Management Coordinator - (Remote)
Highmark Inc. —Delaware
- $19.66 - $27.42 an hour
- Full-time
- Remote
- Writing skills
- HIPAA
- High school diploma or GED
1d
Clinical Client Integration Specialist - Remote
Highmark Inc. —Pennsylvania
- $86,400 - $138,600 a year
- Full-time
- Remote
- Nursing
- RN License
- 5 years
9d
Pharmacy Coordinator
Highmark Inc. —Pennsylvania
- $19.39 - $24.19 an hour
- Full-time
- Remote
- Microsoft Word
- Microsoft Outlook
- Mid-level
Member Engagement Guide - Remote in Central PA.
Highmark Health —Pennsylvania
- $25.02 - $38.76 an hour
- Full-time
- Remote
- 6 years
- Writing skills
- Research
- Vision insurance
HRIS Consultant
Highmark Health —Pennsylvania
- $108,600 - $180,600 a year
- Full-time
- Remote
- Computer Science
- Office
- Ability to lift 50 pounds
Care Manager RN - Utilization Management (UM) Remote
Highmark Inc. —Pennsylvania
- $68,400 - $105,900 a year
- Full-time
- Remote
- Nursing
- RN License
- Computer literacy
9d
Hierarchical Condition Category (HCC) Coding Specialist
Highmark Inc. —Pennsylvania
- $27.02 - $41.85 an hour
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- Mid-level
9d
Imaging Institute - Neuroradiologist - Remote
Allegheny Health Network —Remote
- $420,000 - $1,100,000 a year
- Full-time
- Remote
- Medicine
- BC/BE
- Senior level
- Loan repayment program
- Disability insurance
Internal Business Systems Analyst
Highmark Inc. —Pennsylvania
- $58,100 - $90,000 a year
- Full-time
- Remote
- Mid-level
- Office
- High school diploma or GED
10d
Associate IT Audit Analyst
Highmark Health —Pennsylvania
- $58,100 - $90,000 a year
- Full-time
- Remote
- CPA
- Computer Science
- Writing skills
- Health insurance
10d
Sales Executive
Allegheny Health Network —Pennsylvania
- $64,000 - $96,000 a year
- Full-time
- Remote
- Mid-level
- Office
- 3 years
Imaging Institute - Musculoskeletal Radiologist - Remote, Evening
Allegheny Health Network —Remote
- $420,000 - $1,100,000 a year
- Full-time
- Remote
- Medicine
- Senior level
- Radiology
- Loan repayment program
- Disability insurance
Business Analyst - Sponsored Programs Financial Services - Clinical Trials
Allegheny Health Network —Pennsylvania
- $25.87 - $40.48 an hour
- Full-time
- Remote
- Writing skills
- Mid-level
- Finance
14d
Associate Managed Care Analyst
Allegheny Health Network —Pennsylvania
- $34.29 - $54.25 an hour
- Full-time
- Remote
- Microsoft Excel
- Mid-level
- Finance
7d
Coordinator Billing - Medicine Institute - Remote - Full Time
Allegheny Health Network —Pennsylvania
- $19.75 - $30.22 an hour
- Full-time
- Remote
- Management
- HIPAA
- Mid-level
1d
Imaging Institute - Cardiothoracic Physician - Remote
Allegheny Health Network —Remote
- $420,000 - $1,100,000 a year
- Full-time
- Remote
- Medicine
- BC/BE
- Patient care
- Loan repayment program
- Disability insurance
Clinical Transformation Consultant - Central PA/Lehigh Valley
Highmark Inc. —Pennsylvania
- $79,300 - $127,100 a year
- Full-time
- Remote
- Microsoft Excel
- 5 years
- Public speaking
- Opportunities for advancement
Senior Sales Executive - HNAS
Highmark Inc. —California
- $72,000 - $108,000 a year
- Full-time
- Remote
- 5 years
- Ability to lift 50 pounds
- Bachelor's degree
HR Shared Services Customer Intake Specialist
Highmark Health —Pennsylvania
- $19.66 - $27.42 an hour
- Full-time
- Remote
- Mid-level
- Office
- Ability to lift 50 pounds
1d
Senior Transformation Consultant
Highmark Health —Pennsylvania
- $108,600 - $180,600 a year
- Full-time
- Remote
- Writing skills
- Office
- Ability to lift 50 pounds
8d

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Associate Care Management Coordinator - (Remote)

Highmark Inc. -
Delaware

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Job Details

Full-time
$19.66 - $27.42 an hour
1 day ago

Qualifications

Customer communication

Full Job Description

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

Perform accurate and timely processing of pre-certification requests for authorization of medically necessary health care services at the appropriate level of care, based on the benefits for the line of business, and in compliance with the organization's policies, procedures and regulatory requirements. Document, process and route requests for services to the nurse reviewer and other departments based on documentation procedures, including review type, clinical information, and decision timeframes. Follow policies and procedures to assure case completion and compliance with state and federal regulatory agencies. Maintain or exceed department standards for call volume, response time and related production and quality measures. May interact with other departments and providers to resolve cases.

ESSENTIAL RESPONSIBILITIES:

Communicate effectively
- Proactively inform designated individuals of the status of work assignment to assure decision timeframes and notification requirements are met
- Communicate effectively with Utilization Management Staff, providers, other internal and external customers and management

Route Cases Based on Established Guidelines
- Provide accurate and timely routing of service requests to the nurse reviewer to assure that the decision and notification timeframes are in compliance with regulatory guidelines
- Process service requests meeting established guidelines, and document and route requests that are not permitted
- Request additional information verbally and in writing when the information provided is not adequate to make a medical necessity determination

Maintain or exceed department call center standards
- Adhere to line of business phone standards to assure regulatory requirements are met
- Utilize phone functions to monitor the number of calls in queue and wait time
- Utilize daily phone standard reports to assess opportunities for self improvement
- Meet or exceed standards for other production and quality measures

Other duties as assigned or requested.

QUALIFICATIONS

Preferred

High School Diploma / GED
Experience in customer service
Experience in typing, keyboard and computer skills
Work experience in medical terminology
Associates degree or certification in a health related occupation
Work experience with ICD-9 and/or CPT coding

Language (Other than English):

None

Travel Requirement:

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

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’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’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.

Pay Range Minimum:

$19.66

Pay Range Maximum:

$27.42

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

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 [email protected]

California Consumer Privacy Act Employees, Contractors, and Applicants Notice

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Refine Your Search

highmark health remote jobs

Associate Care Management Coordinator - (Remote)

Clinical Client Integration Specialist - Remote

Pharmacy Coordinator

Member Engagement Guide - Remote in Central PA.

HRIS Consultant

Care Manager RN - Utilization Management (UM) Remote

Hierarchical Condition Category (HCC) Coding Specialist

Imaging Institute - Neuroradiologist - Remote

Internal Business Systems Analyst

Associate IT Audit Analyst

Sales Executive

Imaging Institute - Musculoskeletal Radiologist - Remote, Evening

Business Analyst - Sponsored Programs Financial Services - Clinical Trials

Associate Managed Care Analyst

Coordinator Billing - Medicine Institute - Remote - Full Time

Imaging Institute - Cardiothoracic Physician - Remote

Clinical Transformation Consultant - Central PA/Lehigh Valley

Senior Sales Executive - HNAS

HR Shared Services Customer Intake Specialist

Senior Transformation Consultant

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