Senior Clinical Quality Performance Specialist Amerihealth Caritas Health PlanSenior Clinical Quality Performance SpecialistManchester, NHRemoteManages activities related to plan accreditation, preventive health improvement, business analysis, and clinical and service quality improvement, including state withholds, Healthcare Effectiveness Data and Information Set (HEDIS), and Consumer Assessment of Healthcare Providers and Systems (CAHPS). Role Overview: The Senior Clinical Quality Performance Specialist is responsible for overseeing, designing, and implementing quality initiatives, identifying root causes, establishing and executing work plans to implement effective interventions.
Account Executive Amerihealth Caritas Health PlanAccount ExecutiveBaton Rouge, LARemoteThe primary responsibility of Account Executive is to develop strong relationships with providers to drive for performance, specifically as it relates to core providers as determined by the program who are in fee for service programs and may include PCPs, OB/GYNs, high volume specialists, and FQHCs. Maintains in depth understanding of Plan's contracts and provider performance and needs, identifying, and conducting relevant and tailored provider orientation sessions, making educational visits and working to resolve provider issues.
Provider Practice Performance Advisor Amerihealth Caritas Health PlanProvider Practice Performance AdvisorBaton Rouge, LARemoteThe Performance Practice Advisor, is part of the POD support model and provides support to the Provider Network Management team and Provider Network responsible for producing and presenting performance reports, VBC models, care coordination effectiveness and practice efficiencies. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs.
Senior Account Executive Amerihealth Caritas Health PlanSenior Account ExecutiveBaton Rouge, LARemoteResponsible for hospital and physician network development and management; including joint operating committees (JOC) for identified groups, oversight of necessary quality review meetings with targeted providers and/or health systems. The primary responsibility of Account Executive Sr. is to develop strong relationships with providers to drive for performance specifically as it relates to core providers who are on risk-based or cost sharing VBC arrangements as well as large health system contracts.
Director Provider Network Management Amerihealth Caritas Health PlanDirector Provider Network ManagementManchester, NHReporting directly to the Market President and serving as a key member of the Executive Leadership Team, this leader will drive provider network performance, affordability, quality outcomes, population health initiatives, and provider satisfaction while strengthening AmeriHealth Caritas' position as the preferred healthcare partner throughout New Hampshire. Lead complex negotiations with hospitals, health systems, physician groups, ancillary providers, and clinically integrated networks, including Value-Based Care (VBC) agreements and alternative payment models.
Director Network Performance & Engagement Amerihealth Caritas Health PlanDirector Network Performance & EngagementSouthfield, MIActively partners with the Market Director of Quality to drive Company-wide and Plan quality initiatives, such as Healthcare Effectiveness Data and Information Set (HEDIS), Consumer Assessment of Healthcare Providers and Systems (CAHPS), and National Committee for Quality Assurance/Utilization Review Accreditation Commission (NCQA/URAC), and analytics teams to ensure alignment on performance strategies. Role Overview: The Director, Provider Network Performance & Engagement is responsible for leading strategies and initiatives to optimize provider network performance, advance value-based contracting, and strengthen provider relationships.
Instructional Designer Amerihealth Caritas Health PlanInstructional DesignerPhiladelphia, PARole Overview: The Instructional Designer is an integral part of learning execution, and this job family exists to ensure that training materials and experiences are designed to enable the acquisition and application of knowledge and skills for Enterprise Operations Associates. Responsibilities: Applies instructional design expertise and methodologies to create new and update current essential training offerings (update facilitator/participant guides, job aids, quick reference guides, and eLearning content).
Manager Social Care Amerihealth Caritas Health PlanManager Social CareGreenville, NCRemoteThis role serves as a hands-on, working leader who directly engages with community organizations while overseeing the day-to-day operations and performance of Social Care Partners. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs.
Supervisor Provider Network Operations Amerihealth Caritas Health PlanSupervisor Provider Network OperationsSouthfield, MIRemoteRole Overview: The Provider Network Operations Supervisor supports the daily operations of the Provider Network Operations team by overseeing staff performance, ensuring operational efficiency, and maintaining compliance with internal policies and contractual requirements. Work Arrangement: Remote - This position is fully remote; the candidate must be located in Michigan (MI) and attend monthly meeting as needed in Southfield, MI.
Community Health Navigator Amerihealth Caritas Health PlanCommunity Health NavigatorSouthfield, MIRole Overview: The Community Health Navigator focuses on engaging members through outreach and in-person visits, identifying and addressing Social Determinants of Health (SDOH) needs, improving access to healthcare services, and supporting members in navigating available benefits, community resources, and promoting preventive care, reducing barriers to care, and connecting members to programs that support their overall health and well-being. Informs members of the required actions to fulfill Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment (EPSDT), and Plan requirements, as well as other referred outreach, via phone calls or home visits, and encourages them to comply.
NewTransition Care Manager Amerihealth Caritas Health PlanTransition Care ManagerBaton Rouge, LARemoteRole Overview: The Transition Care Manager is responsible for completing preventive, multidisciplinary discharge planning for plan members presenting to the Emergency Room and/or Acute Setting, in accordance with AmeriHealth Caritas policies and procedures. Current and unrestricted Licensed Professional Counselor (LPC) or Licensed Clinical Social Worker (LCSW) licensure to practice in the state of Louisiana is required.
Network Contractor Provider Network Management Amerihealth Caritas Health PlanNetwork Contractor Provider Network ManagementBaton Rouge, LARemoteAs one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. Contractors will work with Corporate Provider Network Management to manage the annual contracting schedule as well as supplement the network as new providers are available or needed.
Senior Provider Network Operations Analyst Amerihealth Caritas Health PlanSenior Provider Network Operations AnalystSouthfield, MIRemoteRole Overview: The Senior Provider Network Operations Analyst serves as a subject matter expert within Provider Network Operations and is responsible for operational accuracy, regulatory compliance, claims configuration, provider data, and related network operations. User Acceptance Testing (UAT)/Client Review & audit (provider data, Appian Advanced Group ID (AGID) configuration, and set-up concentration) reviews requests prior to initial submission to Enterprise Operations (EO) and claims post-production.
Behavioral Health Caseworker AmeriHealth CaritasBehavioral Health CaseworkerGreenville, SCThe Behavioral Health Case Worker develops a plan of care through shared decision-making with the Member/caregiver and in collaboration with providers and other care team members to improve the Member’s health status and compliance with treatment plans and promote self-management. + 2 years of proven professional experience working directly with SMI members (Serious Mental illnesses) aged six and up who may have one of the following conditions: Psychotic Disorders, Bipolar Disorders, Major Depression.
Instructional Designer AmeriHealth CaritasInstructional DesignerPhiladelphia, PARole Overview: The Instructional Designer is an integral part of learning execution, and this job family exists to ensure that training materials and experiences are designed to enable the acquisition and application of knowledge and skills for Enterprise Operations Associates. Responsibilities: Applies instructional design expertise and methodologies to create new and update current essential training offerings (update facilitator/participant guides, job aids, quick reference guides, and eLearning content).
Network Contractor Provider Network Management AmeriHealth CaritasNetwork Contractor Provider Network ManagementBaton Rouge, LARemoteContractors will work with Corporate Provider Network Management to manage the annual contracting schedule as well as supplement the network as new providers are available or needed. As one of the nation''s leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs.
Director Network Performance & Engagement AmeriHealth CaritasDirector Network Performance & EngagementSouthfield, MIActively partners with the Market Director of Quality to drive Company-wide and Plan quality initiatives, such as Healthcare Effectiveness Data and Information Set (HEDIS), Consumer Assessment of Healthcare Providers and Systems (CAHPS), and National Committee for Quality Assurance/Utilization Review Accreditation Commission (NCQA/URAC), and analytics teams to ensure alignment on performance strategies. Role Overview: The Director, Provider Network Performance & Engagement is responsible for leading strategies and initiatives to optimize provider network performance, advance value-based contracting, and strengthen provider relationships.
Director Network Performance & Engagement AmeriHealth CaritasDirector Network Performance & EngagementSouthfield, MIActively partners with the Market Director of Quality to drive Company-wide and Plan quality initiatives, such as Healthcare Effectiveness Data and Information Set (HEDIS), Consumer Assessment of Healthcare Providers and Systems (CAHPS), and National Committee for Quality Assurance/Utilization Review Accreditation Commission (NCQA/URAC), and analytics teams to ensure alignment on performance strategies. Role Overview: The Director, Provider Network Performance & Engagement is responsible for leading strategies and initiatives to optimize provider network performance, advance value-based contracting, and strengthen provider relationships.
Community Educator AmeriHealth CaritasCommunity EducatorFayetteville, NCOur offerings include integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. + Support member retention and assist auto enrollees with the selection of primary care physicians, explain program benefits and assist in follow-up to Member Services for members with concerns.
Care Connector Bilingual AmeriHealth CaritasCare Connector BilingualWashington, DCWe offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs.