59 Results for

AmeriHealth Caritas Jobs in the United States

Jobs

Customer Service Representative - Bilingual AmeriHealth Caritas

Charleston, SC

Under the direct supervision of Operation Supervisors, the Customer Service Representative is responsible for supporting a diverse membership community and their providers as well as other customers in a timely manner. Our services include integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

1 day ago

Care Connector AmeriHealth Caritas

Remote

The Care Connector elicits information from Members through surveys and questionnaires provided by the care management platform and identifies Members with Care Gaps/HEDIS related health conditions and social determinants of health needs. Interacts with Members, providers and other AmeriHealth Caritas Family of Companies staff to implement program interventions, document activities and refer risk appropriate Members to professional/licensed staff according to protocols.

20 days ago

Care Manager II (Foster Care) AmeriHealth Caritas

Florence, SC

The 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. Our services include integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

3 days ago

Senior Clinical Quality Performance Specialist Amerihealth Caritas Health Plan

Manchester, NH

Remote

Manages 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.

26 days ago

Community Educator Amerihealth Caritas Health Plan

Conway, NH

Remote

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. 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.

28 days ago

Service Coordinator-CHC AmeriHealth Caritas

East Stroudsburg, PA

Remote

3+ 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.

7 days ago

Community Health Navigator AmeriHealth Caritas

Washington, DC

$64,300–$87,700 / year

Exercises judgment and discretion in coordinating care by handling basic care follow-up tasks and collaborating with AmeriHealth Caritas care management teams, community-based health care providers, and other organizations. As one of the nation's leaders in healthcare 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.

30+ days ago

Pharmacy Director AmeriHealth Caritas

Newtown Square, PA

Remote

As a key member of the plan’s management team, this role will oversee the clinical and operational aspects of the pharmacy benefit, with a focus on improving outcomes and providing cost-effective care for Long-Term Services and Supports (LTSS) members enrolled in the Pennsylvania Community HealthChoices (CHC) program. + Develop and implement, in collaboration with the PBM, new process improvements and programs, analyze and evaluate ongoing effectiveness, identify and implement enhancements: + PBM oversight, including monitoring of benefit configuration and claims adjudication accuracy, formulary compliance, SLAs, as well as annual review of P&P and reference guides.

10 days ago

Network Contractor - Provider Network Management (Pnm) Amerihealth Caritas Health Plan

Southfield, MI

Structures contracts that support quality initiatives such as: Healthcare Effectiveness Data and Information Set (HEDIS), Consumer Assessment of Healthcare Providers and Systems (CAHPS), National Committee for Quality Assurance (NCQA), and Utilization Review Accreditation Commission (URAC). Supports contracting activities across multiple product lines, including Long-Term Services and Supports (LTSS), Exchange (ACA Marketplace plans), and Dual Special Needs Plans (DSNP).

30+ days ago

Provider Network Contractor AmeriHealth Caritas

Southfield, MI

30+ days ago

Manager Social Care Amerihealth Caritas Health Plan

Greenville, NC

Remote

This 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.

30+ days ago

Special Investigator AmeriHealth Caritas

Washington, DC

Remote

$80,400–$109,500 / year

We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. The Investigator is responsible for conducting comprehensive investigations of reported, alleged or suspected fraud involving the full range of products at the AmeriHealth Caritas Family of Companies (ACFC).

30+ days ago

Account Executive AmeriHealth Caritas

Southfield, MI

Remote

Role Overview: The 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.

15 days ago

Provider Practice Performance Advisor AmeriHealth Caritas

Southfield, MI

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.

15 days ago

Senior Account Executive AmeriHealth Caritas

Southfield, MI

Remote

Role Overview : 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. + Responsible 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.

15 days ago

Coordinator Provider Network AmeriHealth Caritas

Southfield, MI

Remote

Role Overview: The Coordinator, Provider Network Operations supports the Provider Network Operations team in managing Plan operational functions and activities; key responsibilities include: Work Arrangements: 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.

15 days ago

Senior Provider Network Operations Analyst AmeriHealth Caritas

Southfield, MI

Remote

Role 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.

17 days ago

Network Contractor Provider Network Management AmeriHealth Caritas

Baton Rouge, LA

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. Role Overview: The primary responsibility of the Network Contractor is contracting providers, the contracting and re-contracting of providers in an established market.

30+ days ago

Network Contractor Provider Network Management (Pnm) Amerihealth Caritas Health Plan

Baton Rouge, LA

30+ days ago

Network Contractor - Provider Network Management (Pnm) Amerihealth Caritas Health Plan

Baton Rouge, LA

30+ days ago

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