Head of Case Management & Clinical Operations

Highmark Health; Pittsburgh (Allegheny County); Sur place; USD 120 000 - 160 000; Plein temps

Résumé du poste

Highmark Health, based in Pittsburgh, seeks a leader to drive strategic development of clinical care management and to oversee clinical operations. The role emphasizes establishing reliable processes and technology, directing policy standardization, and leading performance improvement through KPIs.

Collaboration with physicians, nursing leadership and revenue cycles is essential to align utilization management with patient care goals.

Qualifications

• Bachelor’s degree in Nursing, Business, Health Care Management or related field.
• Master’s degree preferred.
• Management experience in healthcare insurance or healthcare industry with a nursing background.

Responsabilités

• Leads development and oversees policies and procedures; standardizes CM policies, practices, workflow and data reporting.
• Directs quality patient care and compliance activities; manages through KPIs and educates teams for improvement.
• Manages daily through EPIC and collaborates with administrative medical staff across the system.
• Develops strategic, tactical, and financial plans to optimize clinical operations and utilization management.

Connaissances

Leadership

Healthcare management

Policy development

Data reporting

Epic (EPIC)

Formation

Bachelor’s degree in Nursing, Business, Health Care Management or related field

Master’s degree (preferred)

Outils

EPIC

Description du poste

Highmark Health, based in Pittsburgh, seeks a leader to drive strategic development of clinical care management and to oversee clinical operations. The role emphasizes establishing reliable processes and technology, directing policy standardization, and leading performance improvement through KPIs.

Collaboration with physicians, nursing leadership and revenue cycles is essential to align utilization management with patient care goals.