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.
Account Executive AmeriHealth CaritasAccount 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.
Practice Performance Advisor AmeriHealth CaritasPractice 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 CaritasSenior Account ExecutiveBaton Rouge, LARemoteThe 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.
Community Health Navigator AmeriHealth CaritasCommunity 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.
Senior Provider Network Operations Analyst AmeriHealth CaritasSenior 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.
Service Coordinator AmeriHealth CaritasService CoordinatorPittsburgh, PARemote3+ 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.
Customer Service Representative AmeriHealth CaritasCustomer Service RepresentativeJacksonville, FLUnder 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.
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 Network Contractor AmeriHealth CaritasProvider Network ContractorSouthfield, MIStructures 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).
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.
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.
NewCommunity Health Navigator AmeriHealth CaritasCommunity 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.
Provider Account Executive AmeriHealth CaritasProvider Account ExecutiveColumbia, SCThe 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.
Service Coordinator AmeriHealth CaritasService CoordinatorReading, 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.
Service Coordinator AmeriHealth CaritasService CoordinatorHarrisburg, 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.
Senior Account Executive AmeriHealth CaritasSenior 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.
Provider Practice Performance Advisor AmeriHealth CaritasProvider 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.
Community Health Navigator AmeriHealth CaritasCommunity Health NavigatorWashington, DC$64,300–$87,700 / yearExercises 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.
Behavioral Health Coordinator / Clinical Liaison AmeriHealth CaritasBehavioral Health Coordinator / Clinical LiaisonConcord, NHUnder the supervision of the Integrated Healthcare Management Manager, the Behavioral Health Coordinator/Clinical Liaison is responsible for identifying, assessing, planning, coordinating, and implementing appropriate, cost-effective, and quality healthcare services for individuals requiring additional assistance in accessing behavioral health services. Investigates and assists in the resolution of issues referred to the Health Plan from the Medicaid agency including, but not limited to, pharmacy, claims, member appeals, medical and dental provider network issues, care delivery, access to care, expedited enrollment, and residential and long-term placement for behavioral health members.