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.
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.
NewAdministrative Assistant / Coordinator AmeriHealth CaritasAdministrative Assistant / CoordinatorNewtown Square, PARemoteThis role facilitates timely and accurate preparation of participants, documentation, and evidentiary submissions to the Pennsylvania Department of Human Services, Bureau of Hearing and Appeals (“DHS/BHA”) while working closely with attorneys, compliance teams, case management, grievance specialists, and external agencies. The Coordinator, State Fair Hearings, supports the organization’s legal, compliance, and appeals functions by preparing, coordinating, and managing all administrative activities related to State Fair Hearings (“SFH”).
Care Connector AmeriHealth CaritasCare ConnectorWashington, DCRemoteThe 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.
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.
Behavioral Health Caseworker AmeriHealth CaritasBehavioral Health CaseworkerGeorgetown, 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.
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.
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.
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).
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.
NewProvider Enrollment Specialist AmeriHealth CaritasProvider Enrollment SpecialistNewtown Square, PAThe Provider Enrollment Specialist, under the direct supervision of the Provider Enrollment Supervisor, is responsible for maintaining participating and non‑participating provider records in the provider database, mapping claims in the invalid provider queue, and resolving provider‑related issues for claims suspended to Provider Enrollment. Our services include integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.
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.
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.
NewProvider Claims Service Representative AmeriHealth CaritasProvider Claims Service RepresentativePhiladelphia, PAActively participates in user acceptance testing functions, such as test script development, testing and documentation of test results. Under the general direction of the Operations Call Center Supervisor, responsible for responding in a timely, professional and courteous manner to all customer needs.
Data Management Business Systems Analyst Senior AmeriHealth CaritasData Management Business Systems Analyst SeniorNewtown Square, PARemoteIn accordance with established regular communications with Manager, keeps staff apprised of progress, problems, and objectives, and initiatives discussions and solicits input regarding business priorities, plans, and progress. + Assists in managing large scale projects, leads appropriate resources and determines project requirements and deliverables, to ensure successful implementations to meet ACFC user needs.
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.
NewMedical Director Utilization Management AmeriHealth CaritasMedical Director Utilization ManagementIndianapolis, INRemoteAs 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.
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.
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.
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.