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Results based on filters ( 112 jobs found )

Quality Perform Specialist Clinical

AmeriHealth Caritas
Located in Ohio
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Quality Performance Specialist – Clinical - As part of the Quality ...
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Summary
About the job:
Management team, the Quality Performance Specialist - Clinical is responsible for leading and coordinating the clinical quality review process of member concerns and medical records utilizing standards of care. In addition, responsibilities also include supporting the annual medical record review activities including HEDIS and Clinical Practice Guidelines. The position also supports accreditation and clinical quality performance improvement activities. Responsibilities: - Assist with accreditation and clinical quality...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Clinical Nurse Specialists
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
AmeriHealth Caritas
Certifications / Licenses:
National Committee for Quality Assurance
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
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Detailed Job Information

Contract Specialist

AmeriHealth Caritas
Located in Ohio
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Role Overview: The Contract Specialist connects our team, the health plan, ...
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About the job:
and key stakeholders. This role focuses on building and maintaining collaborative relationships while ensuring contract data and documents are accurately reflected across systems. Responsibilities include hands-on contract administration, issue resolution during contract loading, and maintaining compliance standards. Work Arrangement : Remote; Anywhere within the continental U.S. Responsibilities - Build and maintain positive relationships with internal teams, health plans, and stakeholders. - Ensure contract data and...
Location:
Located in Ohio
Job Type:
Full-Time
Contract
Occupation:
Compensation, Benefits, and Job Analysis Specialists
Career Level / Education:
Bachelor's degree
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
AmeriHealth Caritas
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Provider Network Operations Analyst CPC

AmeriHealth Caritas
Charleston, SC
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Responsibilities: The primary purpose of the job is to be responsible for ...
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About the job:
the maintaining current provider data and provider reimbursement set up, and to address provider/state inquiries as it relates to claim payment issues. Develops the Pricing Agreement Templates (PAT) for all provider reimbursement set up. Ensure that provider payment issues submitted by Provider Network Management or any other source are validated, researched and resolved within established SLA timeframes. Serves as the subject matter expert in State specific health reimbursement rules and provider billing requirements...
Location:
Charleston, SC
Job Type:
Full-Time
Permanent
Occupation:
Medical Records Specialists
Career Level / Education:
Postsecondary nondegree award
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
AmeriHealth Caritas
Certifications / Licenses:
Certified Professional Coder
Certified Billing and Coding Specialist
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Developer Programmer Lead

AmeriHealth Caritas
Newtown Square, PA
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TITLE: Developer Programmer Lead (Job ID 433318) LOCATION: Newtown Square, ...
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About the job:
PA (remote work option 100% of the time) DUTIES: Analyze, design, develop, test, and implement cost-effective software solutions and applications using MS SQL Server, .Net technologies. Use knowledge of application development methods including Agile and Waterfall to produce deliverables. Contribute to Detail Design Sessions and Code Reviews. Troubleshoot and solve design and coding problems by providing first/second level troubleshooting and technical and operational support with limited guidance. Translate business,...
Location:
Newtown Square, PA
Job Type:
Full-Time
Permanent
Occupation:
Software Developers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
AmeriHealth Caritas
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Personal Care Connector

AmeriHealth Caritas
Philadelphia, PA
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Your career starts now. We’re looking for the next generation of health care ...
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Summary
About the job:
leaders. At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. 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. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear...
Location:
Philadelphia, PA
Job Type:
Full-Time
Permanent
Occupation:
Customer Service Representatives
Career Level / Education:
High school diploma or equivalent
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
AmeriHealth Caritas
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Behavioral Health Care Manager

AmeriHealth Caritas
Located in Ohio
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Role Overview : The PerformCare-PA Behavioral Health Clinical Care Manager ...
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Summary
About the job:
is a core participant of the collaborative care team, including the member/family, behavioral health providers, behavioral health service system, and Physical Health (PH)-Managed. Care Organization (MCO) and medical providers, when applicable, as well as the larger primary care team. The Behavioral Health Care Manager is responsible for providing utilization management and both case and care management, as well as supporting and coordinating the behavioral healthcare of members per assigned caseload, with the...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Healthcare Social Workers
Career Level / Education:
Master's degree
Salary:
High Income Jobs ($80K-$99K)
From:
AmeriHealth Caritas
Certifications / Licenses:
Licensed marriage and family therapist
Licensed Social Worker
Licensed Clinical Social Worker
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Application Architect

AmeriHealth Caritas
Newtown Square, PA
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TITLE: Application Architect (Job ID 434013) LOCATION: Newtown Square, PA ...
Details
Summary
About the job:
(remote work option 100% of the time) DUTIES: Develop, configure, code and test programs from specifications using SQL/SQL Server, .Net, and SSIS technologies. Interface with business analysts, project managers and clients to translate and clarify business, technical requirements. Contribute to technical design, the testing of her own work, and to the development of test plans throughout the Software Development Life Cycle (“SDLC”) using modular code development, tuning and optimization. Maintain awareness of...
Location:
Newtown Square, PA
Job Type:
Full-Time
Permanent
Occupation:
Software Developers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
AmeriHealth Caritas
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Actuarial Analyst

AmeriHealth Caritas
Newtown Square, PA
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This role is hybrid and requires 3 days/week in the office in Newtown ...
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Summary
About the job:
Square, PA. Responsibilities Calculates, monitors and assesses impact of benefit and provider reimbursement changes, cost containment programs, on medical cost and trends. Develops and maintains spreadsheets and databases for purposes of trend and data analytics Performs monthly data analysis projects to assist senior analysts Develops forecasting models for re-forecasts and expected budgets Assists in developing cost projections for contact period negotiations. Performs monthly review of outstanding claim liabilities to...
Location:
Newtown Square, PA
Job Type:
Full-Time
Permanent
Occupation:
Actuaries
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
AmeriHealth Caritas
Certifications / Licenses:
Actuarial Exams
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Personal Care Connector

AmeriHealth Caritas
Located in Ohio
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data-type="string"> Description : Your career starts now. We’re looking for ...
Details
Summary
About the job:
the next generation of health care leaders. At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. 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. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Customer Service Representatives
Career Level / Education:
High school diploma or equivalent
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
De jobs
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Customer service representative (Bilingual)

AmeriHealth Caritas
Charleston, SC
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Job Description: Under the direct supervision of Operation Supervisors, the ...
Details
Summary
About the job:
Customer Service Representative is responsible for supporting a diverse membership community and their providers as well as other customers in a timely manner. This includes inbound and outbound engagement with members and/or providers via phone calls or correspondence regarding benefits, eligibility, or customer issues. Must be bilingual (English/Spanish) and demonstrate the ability to perform the responsibilities of the position in either English or Spanish language. Responsibilities: - Conduct Welcome Calls to new...
Location:
Charleston, SC
Job Type:
Full-Time
Permanent
Occupation:
Customer Service Representatives
Career Level / Education:
High school diploma or equivalent
Salary:
Middle Income Jobs ($30K-$49K)
From:
AmeriHealth Caritas
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information
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