Senior Community Health Educator AmeriHealth CaritasSenior Community Health EducatorGaylord, MIRole Overview: The Community Health Educator, Senior supports the development and execution of outreach strategies within an assigned territory to improve health outcomes, reduce healthcare costs, and increase member engagement. This role delivers health education, supports community-based programming, assists with Social Determinants of Health (SDOH) surveys, and documents outreach activities and outcomes in Jiva.
Strategy & Planning Analyst AmeriHealth CaritasStrategy & Planning AnalystNewtown Square, PAThe Strategy and Planning Analyst is responsible for assisting in several key functions of the department: (1) Board of Directors and Committee Engagements, (2) Corporate and Growth Strategy (3) Enterprise Business Plan and (4) Office of the CEO/President Support. The individual will help shape and synthesize enterprise strategy, support development and consolidation of the Enterprise Business Plan and related market/functional plans, and translate complex inputs into clear, executive-ready narratives.
Account Executive AmeriHealth CaritasAccount ExecutiveManchester, NHstrong>Role Overview: We’re seeking a detail-oriented and relationship-driven Account Executive to manage and support our network of contracted healthcare providers. You’ll monitor provider performance using data and metrics, support credentialing processes, and help drive improvements in service delivery.
Account Executive AmeriHealth CaritasAccount ExecutiveCharleston, SCRemoteThe 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.
Network Contractor Provider Network Management AmeriHealth CaritasNetwork Contractor Provider Network ManagementCharleston, SCRemoteAs 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. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.
Manager Applications Development AmeriHealth CaritasManager Applications DevelopmentRobbinsville, NJRemote$145,300–$198,000 / yearThe Manager Application Development will lead a cross-functional team supporting the CYBER platform , New Jersey’s Children’s Behavioral Health system, which serves as a statewide system for care coordination, utilization management, and outcomes tracking. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.
Care Manager II AmeriHealth CaritasCare Manager IILancaster, SCThe Care Manager II 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, compliance with treatment plans and promote self-management. Serves as the primary point of contact for the care team that includes Members, physicians as well as community supports to guide members in achieving their optimal level of health.
Vice President Provider Network Management AmeriHealth CaritasVice President Provider Network ManagementIndianapolis, INRemoteThe Vice President, Provider Network Management serves as the enterprise leader for provider contracting and network management activities across markets and lines of business and is a key leader in shaping provider network strategy. This role also leads cross-functional collaboration with business development, pricing, actuarial, operations, provider relations, claims, sales, marketing, and technology teams to ensure provider network strategy is aligned with business needs and regulatory requirements.
Provider Practice Performance Advisor AmeriHealth CaritasProvider Practice Performance AdvisorSouthfield, MIstrong>Role Overview: The Performance Practice Advisor supports the Provider Network Management (PNM) team within a POD-based staffing care model, focusing on provider performance, value-based care (VBC) initiatives, and quality outcomes. This role analyzes provider performance data, identifies improvement opportunities, and partners with providers and internal teams to drive improvements in quality, cost, and overall care delivery.
Strategy & Planning Analyst Sr AmeriHealth CaritasStrategy & Planning Analyst SrNewtown Square, PAThe Senior Strategy and Planning Analyst is responsible for supporting and independently driving several key functions of the department: (1) Board of Directors and Committee Engagements, (2) Corporate and Growth Strategy, (3) Enterprise Business Plan, and (4) Office of the CEO/President Support. This role requires strong judgment, discretion, and the ability to manage multiple, time-sensitive deliverables across Board governance, strategic initiatives, business planning, and CEO-sponsored projects.
Behavioral Health Caseworker AmeriHealth CaritasBehavioral Health CaseworkerGaffney, SCRemoteThe 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.
Application Architect AmeriHealth CaritasApplication ArchitectNewtown Square, PAMust have 5 years of experience with the following: Working with IT application architecture in healthcare products; Using MS SQL server to write complex queries to pull data, analyze and generate reports, write stored procedures, functions, and triggers for new application development, and debug, review and apply performance tuning to existing code; Working with GIT source code version control; and Using DevOps and Agile development methodologies to architect applications utilizing Scrum ceremony framework. Must have 2 years of experience with the following: Using cloud technologies such as Azure or AWS to design and develop cloud-based applications; and Using Optum CES (Claims Edit System) to manage product upgrades, support regular LCD (Local Coverage Determinations), NCD (National Coverage Determinations) and KB (Knowledge Base) updates, and perform production support to identify points of failure in the product.
NewCare Manager AmeriHealth CaritasCare ManagerDover, DERemoteMeets regularly with designated partners regarding plan-identified members for care management, assists with reducing/resolving problems and or barriers so that the ACDE Care Coordinator may provide members with high-quality care management services. + Completes comprehensive person-centered assessment, inclusive of physical health history, mental health history, social determinants of health, and supportive needsCoordinates physical, behavioral health, and social services.
Supervisor Service Coordinator AmeriHealth CaritasSupervisor Service CoordinatorPhiladelphia, PAThe Service Coordination Supervisor is responsible for overseeing the operational functions of the LTSS Service Coordination team using the AmeriHealth Caritas Pennsylvania Community Health Choices model of care. + Oversees the day to day operations of the LTSS department, including the development of Person-Centered Service Plans, authorization and approval of services and the coordination of benefits for all LTSS Participants.
Supervisor, Care Management AmeriHealth CaritasSupervisor, Care ManagementManchester, NHRemoteResponsibilities: Provide day-to-day leadership, direction, and oversight of the Care Management team, including staff responsible for case management screening, care coordination, case management, and related support services. Ensure team members receive appropriate orientation, training, and ongoing development related to organizational policies, departmental procedures, and clinical best practices.
Manager, Behavioral Health Clinical Liaison/Operations AmeriHealth CaritasManager, Behavioral Health Clinical Liaison/OperationsDublin, OHRemoteCollaborate with internal teams (Utilization Management (UM), Integrated Health Care Management (IHCM), Long-Term Services and Supports (LTSS) to support care coordination and service delivery. Role Overview: The Manager, Behavioral Health Clinical Liaison, is responsible for supporting the development, implementation, and monitoring of programs that promote whole-person integrated physical and behavioral healthcare.
NewBrightStart Maternity Care Manager AmeriHealth CaritasBrightStart Maternity Care ManagerDublin, OHRemoteRole Overview: The BrightStart Care Manager partners with members, caregivers, providers, and community resources to assess needs, develop individualized care plans, address barriers to care, and promote self-management with complex medical, behavioral health, and social needs by providing comprehensive care coordination and case management to help members achieve their optimal level of health and improve overall health outcomes. Support members experiencing complex conditions, including behavioral health disorders, chronic conditions, maternal health needs, oncology diagnoses, and transition-of-care needs.
Community Educator AmeriHealth CaritasCommunity EducatorManchester, NHBased out of our Manchester Wellness Center and traveling statewide, this role promotes AmeriHealth Caritas programs through community events and site visits, identifies and guides potential Medicaid and uninsured individuals to appropriate services, and educates them on enrollment processes. Role Overview: AmeriHealth Caritas New Hampshire (ACNH) is seeking a passionate and community-driven Community Educator to join our outreach team and help connect vulnerable and diverse populations across the state to essential healthcare resources.
Service Coordinator-CHC AmeriHealth CaritasService Coordinator-CHCScranton, PAYou will contribute to the care coordination process by performing face-to-face assessments to identify, evaluate, coordinate, and manage participant's needs, including physical health, behavioral health, social services, and long-term services and support, as well as telephonic follow-up. + Identify, coordinate, and assist participants in accessing needed LTSS services and other Covered Services, as well as non-covered medical, social, housing, educational, and other services and supports.
BrightStart Maternity Care Manager AmeriHealth CaritasBrightStart Maternity Care ManagerSouthfield, MIRemoteDevelops a care plan 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, as well as promote self-management. Role Overview: The Care Manager is responsible for managing and coordinating care, services, and social determinants of health for medically fragile members with acute, chronic, medically complex, and/or behavioral health conditions, as well as other health needs.
Behavioral Health Care Manager AmeriHealth CaritasBehavioral Health Care ManagerSouthfield, MI3 or more years of experience at the bedside working with high acuity behavioral health needs and/or medically frail patients in an acute care, home care, or special needs clinic 3 or more years of case management experience, preferably by telephone, within a managed care organization, is desired. 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, as well as promote self-management.
Senior Community Health Educator AmeriHealth CaritasSenior Community Health EducatorMIRole Overview: The Community Health Educator, Senior supports the development and execution of outreach strategies within an assigned territory to improve health outcomes, reduce healthcare costs, and increase member engagement. This role delivers health education, supports community-based programming, assists with Social Determinants of Health (SDOH) surveys, and documents outreach activities and outcomes in Jiva.
Care Manager II AmeriHealth CaritasCare Manager IIColumbia, SCRemoteThe Care Manager II 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, compliance with treatment plans and promote self-management. Responsible for managing and coordinating care, services, and social determinants of health for Members with acute, chronic, medically complex, and behavioral health conditions and other health needs.
NewBehavioral Health Caseworker AmeriHealth CaritasBehavioral Health CaseworkerSummerville, SCRemoteThe 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.
Behavioral Health Caseworker AmeriHealth CaritasBehavioral Health CaseworkerCharleston, 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.
Care Manager AmeriHealth CaritasCare ManagerDover, DERemoteMeets regularly with designated partners regarding plan-identified members for care management, assists with reducing/resolving problems and or barriers so that the ACDE Care Coordinator may provide members with high-quality care management services. + Completes comprehensive person-centered assessment, inclusive of physical health history, mental health history, social determinants of health, and supportive needsCoordinates physical, behavioral health, and social services.
NewCommunity Educator AmeriHealth CaritasCommunity EducatorJacksonville, 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.
Behavioral Health Care Manager AmeriHealth CaritasBehavioral Health Care ManagerSouthfield, MIDevelops 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, as well as promote self-management. Role Overview: The Care Manager is responsible for managing and coordinating care, services, and social determinants of health for medically fragile members with acute, chronic, medically complex, and/or behavioral health conditions, as well as other health needs.
NewCare Connector AmeriHealth CaritasCare ConnectorPhiladelphia, PARemoteUnder the direction of Clinical staff, the Care Connector will provide members with educational materials and carry out strategies to increase healthcare adherence and reduce barriers to care. 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.
Community Educator AmeriHealth CaritasCommunity EducatorManchester, NHstrong>Role Overview: AmeriHealth Caritas New Hampshire (ACNH) is seeking a passionate and community-driven Community Educator to join our outreach team and help connect vulnerable and diverse populations across the state to essential healthcare resources. Based out of our Manchester Wellness Center and traveling statewide, this role promotes AmeriHealth Caritas programs through community events and site visits, identifies and guides potential Medicaid and uninsured individuals to appropriate services, and educates them on enrollment processes.
Service Coordinator AmeriHealth CaritasService CoordinatorPhiladelphia, PA3+ years of social service (in lieu of a Bachelor’s degree) or related healthcare experience that required the following: + working with people who need personal care services, + conducting face to face visits in the home or nursing facility focused on needs assessments and monitoring delivery of services. You will contribute to the care coordination process by performing face-to-face assessments to identify, evaluate, coordinate, and manage participant's needs, including physical health, behavioral health, social services, and long-term services and support, as well as telephonic follow-up.
Care Manager AmeriHealth CaritasCare ManagerWashington, DC$83,400–$113,600 / yearCoordinates care and services with the Care Coordinator, Community Health Navigator, member, member's caregiver as appropriate, PCP Specialist, complex adulat and pediatric populations and Facility/Vendor Providers. + Minimum of 3 years of independent clinical practice experience as an RN or LICSW working with complex medical and behavioral health diagnoses in acute care, home care, or community health settings.
Care Manager Bright Start AmeriHealth CaritasCare Manager Bright StartColumbia, SCThe Care Manager II 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, compliance with treatment plans and promote self-management. Serves as the primary point of contact for the care team that includes Members, physicians as well as community supports to guide members in achieving their optimal level of health.
Director, Integrated Care Team (ICT) Care Coordination AmeriHealth CaritasDirector, Integrated Care Team (ICT) Care CoordinationSouthfield, MIRemoteRole Overview: The Director, ICT Care Coordination, is responsible for leading the strategic direction, operational execution, and performance of care coordination and population health programs within the assigned market to ensure the delivery of high-quality, compliant, and member-centered clinical and non-clinical services. Responsibilities: Partner with the Market Chief Medical Officer (CMO) and other market leaders to develop, execute, and monitor the plan's population health strategy while supporting equitable, whole-person care for members.
Provider Practice Performance Advisor AmeriHealth CaritasProvider Practice Performance AdvisorSouthfield, MIRole Overview: The Performance Practice Advisor supports the Provider Network Management (PNM) team within a POD-based staffing care model, focusing on provider performance, value-based care (VBC) initiatives, and quality outcomes. This role analyzes provider performance data, identifies improvement opportunities, and partners with providers and internal teams to drive improvements in quality, cost, and overall care delivery.
Senior Clinical Quality Performance Specialist AmeriHealth CaritasSenior 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.
Care Manager II AmeriHealth CaritasCare Manager IIDublin, OHRemoteRole Overview: The Care Manager II partners with members, caregivers, providers, and community resources to assess needs, develop individualized care plans, address barriers to care, and promote self-management with complex medical, behavioral health, and social needs by providing comprehensive care coordination and case management to help members achieve their optimal level of health and improve overall health outcomes. Current, active, and unrestricted Ohio license in good standing as one of the following: Licensed Social Worker (LSW), Licensed Master Social Worker (LMSW), Licensed Independent Social Worker (LISW), or Licensed Professional Counselor (LPC).
Market President Indiana AmeriHealth CaritasMarket President IndianaIndianapolis, INRemoteProvide executive oversight of key functional areas, including Medical Affairs, Operations, Information Services, Quality, Marketing, Regulatory and Legislative Affairs, and Human Resources, ensuring coordinated execution, regulatory compliance, operational excellence, and high-quality member-centered outcomes. Serve as the primary market-facing leader by building and sustaining strong relationships with state agencies, providers, associations, community leaders, and strategic partners to strengthen brand presence, support contract performance, and advance AmeriHealth Caritas’ position in Indiana.
Behavioral Health Caseworker AmeriHealth CaritasBehavioral Health CaseworkerSpartanburg, 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.
NewDir Strategy & Product Develop AmeriHealth CaritasDir Strategy & Product DevelopPhiladelphia, PARemoteThe director partners cross-functionally with Actuarial, Compliance, Legal, Network, Marketing, Sales, and IS to deliver products that meet regulatory requirements, achieve financial targets, and improve member experience in a rapidly evolving regulatory and competitive landscape. Reporting to the President of Exchange Markets, the Corporate Director of Strategy & Product Development - Exchange is responsible for the end-to-end strategy, design, development, and lifecycle management of ACA-compliant products offered on and off the Health Insurance Marketplace.
Care Manager II AmeriHealth CaritasCare Manager IIRock Hill, SCThe Care Manager II 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, compliance with treatment plans and promote self-management. Serves as the primary point of contact for the care team that includes Members, physicians as well as community supports to guide members in achieving their optimal level of health.
Service Coordinator-CHC AmeriHealth CaritasService Coordinator-CHCLewistown, PAYou will contribute to the care coordination process by performing face-to-face assessments to identify, evaluate, coordinate, and manage participant's needs, including physical health, behavioral health, social services, and long-term services and support, as well as telephonic follow-up. + Identify, coordinate, and assist participants in accessing needed LTSS services and other Covered Services, as well as non-covered medical, social, housing, educational, and other services and supports.
Coordinator Mail Services II AmeriHealth CaritasCoordinator Mail Services IIPhiladelphia, PARemoteAs 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. + Research mail or error reports utilizing USPS zip code lookup, data lookup, or claims information, correcting mailing addresses in the system if permitted in the plan contract.
Service Coordinator AmeriHealth CaritasService CoordinatorClearfield, PAYou will contribute to the care coordination process by performing face-to-face assessments to identify, evaluate, coordinate, and manage participant's needs, including physical health, behavioral health, social services, and long-term services and support, as well as telephonic follow-up. + Identify, coordinate, and assist participants in accessing needed LTSS services and other Covered Services, as well as non-covered medical, social, housing, educational, and other services and supports.
Manager, Behavioral Health Clinical Liaison/Operations AmeriHealth CaritasManager, Behavioral Health Clinical Liaison/OperationsDublin, OHRemoteCollaborate with internal teams (Utilization Management (UM), Integrated Health Care Management (IHCM), Long-Term Services and Supports (LTSS) to support care coordination and service delivery. Role Overview: The Manager, Behavioral Health Clinical Liaison, is responsible for supporting the development, implementation, and monitoring of programs that promote whole-person integrated physical and behavioral healthcare.
Care Manager Foster Care AmeriHealth CaritasCare Manager Foster CareFlorence, SCThe Care Manager II 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, compliance with treatment plans and promote self-management. Serves as the primary point of contact for the care team that includes Members, physicians as well as community supports to guide members in achieving their optimal level of health.
NewBrightStart Maternity Care Manager AmeriHealth CaritasBrightStart Maternity Care ManagerDublin, OHRemoteRole Overview: The BrightStart Care Manager partners with members, caregivers, providers, and community resources to assess needs, develop individualized care plans, address barriers to care, and promote self-management with complex medical, behavioral health, and social needs by providing comprehensive care coordination and case management to help members achieve their optimal level of health and improve overall health outcomes. + Support members experiencing complex conditions, including behavioral health disorders, chronic conditions, maternal health needs, oncology diagnoses, and transition-of-care needs.
Quality Perform Specialist Clinical AmeriHealth CaritasQuality Perform Specialist ClinicalRaleigh, NCRemoteAssistance will be based upon the organizations needs annually but may include participation in the development of medical record review tools, conducting training and testing of medical record review staff, and auditing medical record reviews upon completion. 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.
Practice Performance Advisor AmeriHealth CaritasPractice Performance AdvisorCharleston, SCRemoteThe 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.
Director Quality Management AmeriHealth CaritasDirector Quality ManagementHarrisburg, PARemoteThe Director of Quality Management is responsible for the Outcomes Management and Quality Improvement Plan, a program of systematic and objective activities designed to continuously monitor, evaluate, and improve the processes of delivering behavioral health and substance use services, services for intellectual/developmental disabilities, and the quality of clinical care and services provided to children, youth, young adults, and their family/caregivers. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.