Description

JOB SUMMARY

This role is responsible for developing, implementing and executing the comprehensive strategic vision and profound transformation of Highmark’s Enterprise Utilization Management function, ensuring impactful market positioning and cost containment, across all lines of business (e.g., Medicare, Medicaid, commercial, ACA). The incumbent will establish Highmark as an industry leader through strategic and operational transformation that aligns with the organization’s member focused strategy. They are accountable for an operational organization with over 1,000 service level requirements, ensuring compliance and mitigating risks associated with non-compliance with a broad range of government mandates and regulations. They champion continuous improvement and implement industry-best practices to achieve these critical performance and compliance objectives. This role is also responsible for delivering UM operations for external heal...