Maternity Case Manager AmeriHealth CaritasMaternity Case ManagerCharlotte, NCRemoteCoordinates physical, behavioral health and social services; + Provides medication management, including regular medication reconciliation and support of medication adherence; + Identifies problems/barriers for care coordination and appropriate care management interventions. The Maternity Care Manager provides support to pregnant members appropriate for care coordination and case management services in achieving their optimal level of health through self-management.
Part Time Behavioral Health Member Services Specialist AmeriHealth CaritasPart Time Behavioral Health Member Services SpecialistHarrisburg, 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. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.
Director Long Term Services & Support AmeriHealth CaritasDirector Long Term Services & SupportCharleston, SCRemoteServe as primary LTSS subject matter expert and leader responsible for coordinating, overseeing, directing all health plan LTSS operations, inclusive of internal and external communications, regulatory requirements, network development, systems integration, and clinical programs. + Support coordination of LTSS with other services across the continuum of care striving to enhance the quality of member care and provider satisfaction, including participation on multidisciplinary care teams as indicated.
Manager Long Term Services & Support PA CHC AmeriHealth CaritasManager Long Term Services & Support PA CHCAllentown, PARemoteThey will also be the Community HealthChoices Long-Term Service and Support subject matter expert, ensure compliance with program and contractual requirements, assist with developing and managing policies and procedures, and ensure alignment with State and Federal Requirements. 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.
Investigator Sr AmeriHealth CaritasInvestigator SrWashington, DCRemote$92,600–$126,200 / yearWe 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).
Senior Director of Provider Network Operations AmeriHealth CaritasSenior Director of Provider Network OperationsNewtown Square, PARemoteEnsures all provider reimbursement (configuration) documentation including complex Integrated Delivery System contracts is completed timely and accurately, in accordance with State and provider contract requirements inclusive of post-production validation. + Review and respond to operational inquiries from state partners and/or other regulating bodies, Ensures ongoing provider data accuracy through regular reconciliation of the state provider master file, provider rosters, and audits.
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.
Care Manager II AmeriHealth CaritasCare Manager IIDover, 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.
Care Manager AmeriHealth CaritasCare ManagerMillsboro, 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.
Service Coordinator-CHC AmeriHealth CaritasService Coordinator-CHCPhiladelphia, 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 RepresentativePhiladelphia, PAUnder 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.
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.
NewCare Manager II (RN/SW) - HIDE D-SNP AmeriHealth CaritasCare Manager II (RN/SW) - HIDE D-SNPColumbia, SCRemoteIdeal Candidate: An experienced RN or Social Worker with Medicare/Medicaid care management experience who thrives in a remote environment and is passionate about improving outcomes for complex, high-risk dual-eligible members. The Care Manager II (RN/SW) provides remote care management and care coordination for members enrolled in a Highly Integrated Dual Eligible Special Needs Plan (HIDE D-SNP).
Manager Social Care AmeriHealth CaritasManager 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.
Utilization Management Reviewer AmeriHealth CaritasUtilization Management ReviewerWashington, DCRemote$86,000–$117,300 / hourMinimum of 3 years of diverse independent clinical practice experience as a Registered Nurse in outpatient surgery, Medical-Surgical, Critical Care, Skilled Nursing Facility (SNF), Rehabilitation, or Long-Term Acute Care (LTAC) settings. Under the direction of a supervisor, the Utilization Management Reviewer evaluates medical necessity for inpatient and outpatient services, ensuring treatment aligns with clinical guidelines, regulatory requirements, and patient needs.
Behavioral Health Utilization Management Reviewer AmeriHealth CaritasBehavioral Health Utilization Management ReviewerWashington, DCRemote$77,700–$105,900 / yearUsing clinical knowledge and experience, the clinician reviews provider requests for inpatient and outpatient services, working closely with members and providers to collect all information necessary to perform a thorough medical necessity review. The BH UM Reviewer will use professional judgment to evaluate the request to ensure that appropriate services are approved and recognize care coordination opportunities and refer those cases to integrated care management as needed.
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.
NewService Coordinator-CHC AmeriHealth CaritasService Coordinator-CHCErie, 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.
Executive Assistant II AmeriHealth CaritasExecutive Assistant IINewtown Square, PARemoteDevelop, review, edit and draft presentations and documentation in collaboration with the SVP and Leadership team; independently research and analyze associated issues and/or compile materials needed for presentation and/or decision-making purposes; composing correspondence as necessary. + Serves as primary liaison to various internal and external constituencies on behalf of the SVP, including screening correspondence and telephone calls; keeping executive leadership informed of all matters requiring their attention.
Supervisor, Claims Provider Network Operations (PNO) AmeriHealth CaritasSupervisor, Claims Provider Network Operations (PNO)Southfield, 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. + Ensure operational processes align with internal policies, contractual obligations, and service level agreements (SLAs).