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
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.
The incumbent will establish Highmark as an industry leader through strategic and operational transformation that aligns with the organization’s member focused strategy.
This role is also responsible for delivering UM operations for external health plans and administrators, providing executive oversight for operational and processing problems and consequences.
Matching 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.
Skills & Requirements
Must-have
Develop and execute strategic vision
Transform Utilization Management function
Ensure market positioning and cost containment
Champion continuous improvement and best practices
Deliver UM operations for external health plans
Oversee operational and processing problems
Drive digital authorization management solutions
Nice-to-have
Pioneering strategic frameworks
Industry-leading UM practices
Talent and performance management
Employee engagement initiatives
Key Requirements
15+ years in Health Insurance Industry
10+ years in Strategic Operational Planning
10+ years in senior Operational Leadership
10+ years healthcare cost containment experience
Proven hands-on business development experience
Bachelor's degree in Nursing, Health Plan Administration or Business Administration/Management
PMP or Lean Six Sigma Master Black Belt certification preferred