**Company :**
Highmark Inc.
**Job Description :**

**JOB SUMMARY**

This job manages a team of clinicians across PA with staff in Southwest and Lehigh Capital area, charged with promoting quality member outcomes, to optimize member benefits, and to promote effective use of resources. Ensures that care is medically appropriate, high quality, and cost effective. The incumbent is accountable for the oversight; development and maintenance of the department's case management processes. This may include utilization management, strategic planning, care cost initiatives, system development and quality outcomes. Hires, trains, coaches, counsels, and evaluates performance of direct reports. Ensures compliance with NCQA, URAC, CMS, DOH, and DOL regulations. Works closely with other departments within the corporation to resolve issues and ensure activities coincide with Case Management processes.

**ESSENTIAL RESPONSIBILITIES**

+ Manage and coordinate all dep...