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Director, Plan Operations & Administration

AmeriHealth Caritas
Dublin, OH
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**Role Overview:** ;The Director of Plan Operations & Administration is ...
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Summary
About the job:
responsible for ensuring full compliance with state program contractual and regulatory requirements, including benefit and payment rules, data submission standards, and performance benchmarks. Acting as a key liaison between the state, health plan, and enterprise functions, this role drives operational excellence by ensuring contractual obligations and service levels are maintained across corporate, regional, and local operations.**Work Arrangement:**+ Hybrid - The associate must be in the office at least 2 to 3 days per...
Location:
Dublin, OH
Job Type:
Full-Time
Permanent
Occupation:
Compliance Managers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
US.jobs
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
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Detailed Job Information

Community Health Navigator

AmeriHealth Caritas
Dover, DE
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At AmeriHealth Caritas, we’re passionate about helping people get care, stay ...
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About the job:
well, and build healthy communities. 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. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together, we can build healthier communities. We'd like to hear from you if you want to make a difference. Headquartered in Newtown Square, Pennsylvania, AmeriHealth Caritas is a...
Location:
Dover, DE
Job Type:
Full-Time
Permanent
Occupation:
Community Health Workers
Career Level / Education:
High school diploma or equivalent
Salary:
Middle Income Jobs ($30K-$49K)
From:
AmeriHealth Caritas
Certifications / Licenses:
Driver's License
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Bilingual Contract Specialist

AmeriHealth Caritas
Orlando, FL
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Your career starts now. We’re looking for the next generation of healthcare ...
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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 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. 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:
Orlando, FL
Job Type:
Full-Time
Contract
Occupation:
Compliance Officers
Career Level / Education:
Bachelor's degree
Salary:
High Income Jobs ($80K-$99K)
From:
AmeriHealth Caritas
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Healthcare Business Insights Analyst Senior

AmeriHealth Caritas
Located in Ohio
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Role Overview Reporting to the Director of Business Insights, this Business ...
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About the job:
Insights Analyst Senior position will collaborate with operational business owners: 1) to estimate cost and utilization impacts of new business initiatives; 2) to establish the evaluation and monitoring plans; and 3) to execute the developed analytic plan, including creation of business insights and associated visualizations. This position is responsible for providing consultative and collaborative Analytics support throughout the lifecycle of a Value Optimization initiative. Work Arrangement - This is a 100% Remote...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Market Research Analysts and Marketing Specialists
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

Utilization Management Reviewer

AmeriHealth Caritas
Washington, DC
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$5,000.00 SIGN ON BONUS Role Overview Our Utilization Management Reviewers ...
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Summary
About the job:
evaluate medical necessity for inpatient and outpatient services, ensuring treatment aligns with clinical guidelines, regulatory requirements, and patient needs. This role requires reviewing provider requests, gathering necessary medical documentation, and making determinations based on clinical criteria. Using professional judgment, the Clinical Care Reviewer assesses the appropriateness of services, identifies care coordination opportunities, and ensures compliance with medical policies. When necessary, cases are...
Location:
Washington, DC
Job Type:
Full-Time
Permanent
Occupation:
Registered Nurses
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
AmeriHealth Caritas
Certifications / Licenses:
Associate of Science in Nursing
Certified Registered Nurse
Driver's License
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

MCO Director Payment Integrity

AmeriHealth Caritas
Newtown Square, PA
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Role Overview The Director of Payment Integrity Solutions is responsible for ...
Details
Summary
About the job:
overseeing Payment Integrity edit and program strategy and performance across all ACFC lines of business and products (Medicaid, Medicare, Exchange, PBM, BH). This role ensures that implemented solutions deliver measurable value through rigorous analytics, including the use of artificial intelligence (AI), machine learning (ML), and NLP-based automation, coupled with continuous policy refinement, and strong Plan and provider stakeholder engagement. The Director leads efforts to monitor effectiveness, address...
Location:
Newtown Square, PA
Job Type:
Full-Time
Permanent
Occupation:
Management Analysts
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

Manager Healthcare Value Optimization

AmeriHealth Caritas
Newtown Square, PA
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Role Overview Healthcare Value Optimization (HVO) is AmeriHealth Caritas’ ...
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Summary
About the job:
enterprise-wide margin improvement program, which delivers value for the organization through improved member experience, health outcomes, and total cost of care. HVO collaborates closely with functional and market leaders, following a rigorous process to identify, validate, implement, and monitor improvement initiatives across unique workstreams. The Manager position ensures successful execution of margin improvement activities through thought leadership, cross-functional coordination, and proactive problem-solving....
Location:
Newtown Square, PA
Job Type:
Full-Time
Permanent
Occupation:
Management Analysts
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

Customer Service Representative

AmeriHealth Caritas
Charleston, SC
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Job Description: Under the direct supervision of Operation Supervisors, the ...
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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. Responsibilities: - Conducting Welcome Calls to new members and performing Health Assessment Surveys as needed. Providing member education and assists members with Primary Care Physician (PCP)...
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

Provider Network Operations Medicaid Analyst CPC

AmeriHealth Caritas
Charleston, SC
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Responsibilities: The primary purpose of the job is to be responsible for ...
Details
Summary
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
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Director, Plan Operations & Administration

AmeriHealth Caritas
Located in Ohio
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Role Overview: The Director of Plan Operations & Administration is ...
Details
Summary
About the job:
responsible for ensuring full compliance with state program contractual and regulatory requirements, including benefit and payment rules, data submission standards, and performance benchmarks. Acting as a key liaison between the state, health plan, and enterprise functions, this role drives operational excellence by ensuring contractual obligations and service levels are maintained across corporate, regional, and local operations. Work Arrangement: - Hybrid – The associate must be in the office at least 2 to 3 days per week at...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Compliance Managers
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
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