Jobs at Highmark Residential

The Medical Director, Medical Management role at Highmark Inc. leads a physician team responsible for ensuring utilization management aligns with current clinical standards. Key duties include conducting electronic reviews of escalated cases to determine medical necessity, engaging in peer-to-peer discussions, and advising multidisciplinary teams on complex care scenarios. The position also involves developing clinical protocols and managing special projects to improve member care. This opportunity appeals to physicians seeking to impact population health within a collaborative environment that values critical thinking and professional growth. The role is primarily office-based with occasional travel up to 25 percent.

The Medical Director, Medical Management role at Highmark Inc. leads a physician team responsible for overseeing utilization management and ensuring clinical standards align with current regulations. Key duties include conducting electronic reviews of escalated cases to determine medical necessity, participating in multidisciplinary case management teams, and developing clinical protocols. The position offers the opportunity to influence care quality for members while working within a collaborative environment that values physician expertise. The role is primarily office-based with minimal travel requirements and supports professional growth through involvement in special projects and guideline development.

The Medicaid & ACA Manager role supports the strategic and operational execution of Medicaid and Affordable Care Act programs within a trusted Kansas-based healthcare organization. Key responsibilities include building detailed workplans, monitoring performance indicators like medical loss ratios and enrollment trends, and leading cross-functional coordination to ensure regulatory compliance and financial objectives are met. The position appeals to candidates seeking a dynamic environment with a strong emphasis on family, professional growth through training programs, and a collaborative culture that values inclusivity. This full-time position offers flexible work arrangements, including remote, hybrid, or onsite options, for individuals residing in or willing to relocate to Kansas or Missouri.