JOB SUMMARY
A critical focus of this role is driving the organization's healthcare interoperability strategy by championing seamless, bidirectional clinical and administrative data exchange between Highmark and its provider network. This flow of data is essential to optimizing core health plan operations, including case management, utilization management, risk programs, government quality programs, and claims processing.
This job ensures the availability, performance and stability of processes that create, store and deliver data for internal and external stakeholders. To achieve this, the incumbent will lead teams that monitor, maintain and support an efficient and reliable production environment for all of Highmark Health’s analytic and operational data platforms. This includes reactive and proactive support for data engineering patterns that ingest, transform, and curate data; processes that create enriched datasets for use by data consumers; automation of key data product processes (e.g., ACGs, HEDIS); and access to and/or exchange of data through APIs and interoperable feeds. The incumbent will also manage effective and efficient quality control processes to ensure data are trustworthy and robust change control processes that balances our need to be nimble with the requirement of high quality and accuracy.
ESSENTIAL RESPONSIBILITIES
- Lead the strategic roadmap and execution for healthcare data exchange, leveraging deep expertise in both payer and provider technology ecosystems (e.g., EHR/EMR platforms like Epic and Oracle) to bridge technical and operational gaps.
- Ensure robust data integration utilizing modern healthcare standards (e.g., HL7 V2, FHIR) to directly support and improve clinical workflows, population health initiatives, and payer-provider alignment.
- Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
- Monitor, maintain, and support the operational and analytic data platforms and technology, working closely with IT partners to ensure the group is leveraging the latest tools and technology. Oversee an efficient and effective quality control process that tests and reviews all code and processes to ensure accuracy. Create an overall production and continuous improvement discipline that not only delivers on quality, but continuously lowers our cost to deliver.
- Support data and analytic end-users and stakeholder needs for appropriate data access, awareness, understanding, and troubleshooting to ensure successful information delivery.
- Reliably deliver all assets that exist within the production environment (e.g., data sources, curated datasets, APIs, data feeds, analytic & business intelligence tools) on a timely and accurate basis such that end-users can be more efficient and effective in their job.
- Act as the liaison to the Organization's broader data governance processes, data engineering teams, and other key information technology partners. Act as a critical link to IT and our external plan partners who are leveraging our analytical tools.
- Other duties as assigned or requested.
EDUCATION
Required
- Bachelor's Degree in Information Technology, Computer and Information Science, Computer Engineering, Health Informatics or related field
Substitutions
- 6 years of relevant work experience in lieu of a bachelor’s degree
Preferred
- Master's Degree in Information Technology, Computer and Information Science, Computer Engineering or related field
EXPERIENCE
Required
- 7 years in Data Analytics
Preferred
- 10+ years of dedicated experience in healthcare interoperability and clinical data exchange
- 15+ years in Healthcare IT delivery, requiring significant foundational experience on the provider side combined with strategic experience on the payer side
- 5+ years shaping and executing healthcare technology strategy
LICENSES AND CERTIFICATIONS
Required
- None
Preferred
- None
SKILLS
- Healthcare Interoperability (HL7, FHIR, APIs)
- Clinical Data Exchange & Integration Engines
- Healthcare IT Strategy & Delivery
- Payer & Provider Ecosystem Alignment
- Health Plan Operations (Utilization Management, Risk, Claims)
- EHR/EMR Platform Integration
- Healthcare Information Systems
- Health Information Management
- Talent Management
- IT Operations
Language (Other than English)
None
Travel Required
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position type
Office-Based
Teaches / trains others regularly
Frequently
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Pay Range Minimum:
$129,100.00Pay Range Maximum:
$214,500.00Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at [email protected]
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Skills Required
- Bachelor's degree in Information Technology, Computer and Information Science, Computer Engineering, Health Informatics, or a related field
- Six years of relevant work experience may substitute for the bachelor's degree
- Seven years of experience in data analytics
- Master's degree in Information Technology, Computer and Information Science, Computer Engineering, or a related field
- Ten or more years of dedicated experience in healthcare interoperability and clinical data exchange
- Fifteen or more years of healthcare IT delivery experience, including provider-side foundational experience and payer-side strategic experience
- Five or more years shaping and executing healthcare technology strategy
Highmark Health Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Highmark Health and has not been reviewed or approved by Highmark Health.
-
Healthcare Strength — Medical, prescription, dental, and vision coverage are emphasized alongside 100% coverage for preventive exams, with onsite pharmacy access and fitness center availability at major campuses.
-
Retirement Support — An employer‑sponsored 401(k) with a company match is highlighted, with AHN materials illustrating a 100% match on the first 4% plus an additional 1% employer contribution as an example within the enterprise.
-
Wellbeing & Lifestyle Benefits — Wellness programs include stress‑management classes, health coaching, incentives for healthy activities, team‑member discounts, and volunteer incentives, with paid volunteer time also noted in the overall package.
Highmark Health Insights
What We Do
Highmark Health, a Pittsburgh, PA based enterprise that employs more than 40,000 people who serve millions of Americans across the country, is the second largest integrated health care delivery and financing network in the nation based on revenue. Highmark Health is the parent company of Highmark Inc., Allegheny Health Network, and HM Health Solutions. Highmark Inc. and its subsidiaries and affiliates provide health insurance to nearly 5 million members in Pennsylvania, West Virginia and Delaware as well as dental insurance, vision care and related health products through a national network of diversified businesses that include United Concordia Companies, HM Insurance Group, and Visionworks. Allegheny Health Network is the parent company of an integrated delivery network that includes eight hospitals, more than 2,800 affiliated physicians, ambulatory surgery centers, an employed physician organization, home and community-based health services, a research institute, a group purchasing organization, and health and wellness pavilions in western Pennsylvania. HM Health Solutions focuses on meeting the information technology platform and other business needs of the Highmark Health enterprise as well as unaffiliated health insurance plans by providing proven business processes, expert knowledge and integrated cloud-based platforms. A national blended health organization, Highmark Health and our leading businesses support millions of customers with products, services and solutions closely aligned to our mission of creating remarkable health experiences, freeing people to be their best. Headquartered in Pittsburgh, we're regionally focused in Pennsylvania, Delaware, West Virginia and New York, with customers in all 50 states and the District of Columbia. We passionately serve individual consumers and fellow businesses alike. Our companies cover a diversified spectrum of essential health-related needs, including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative technology solutions. We’re also proud to carry forth an important legacy of compassionate care and philanthropy that began more than 170 years ago. This tradition of giving back, reinvesting and ensuring that our communities remain strong and healthy is deeply embedded in our culture, informing our decisions every day.
