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Results based on filters ( 132 jobs found )

Care Manager II

AmeriHealth Caritas
Washington, DC
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Role Overview The Care Manager (RN/LICSW) assists members appropriate for ...
Details
Summary
About the job:
care management and care coordination services in achieving their optimal level of health through self-management. The Care Manager (RN/LICSW) is responsible for engaging the member, member's caregiver and providers to assess, plan, and establish individual member goals. Will facilitate and coordinate care for the members while assuring quality and use of cost-effective resources. The position will function as a single point of contact and be an advocate for members in the care management program. In addition, the Care...
Location:
Washington, DC
Job Type:
Full-Time
Permanent
Occupation:
Healthcare Social Workers
Career Level / Education:
Master's degree
Salary:
Six Figure Jobs (more than $100K)
From:
AmeriHealth Caritas
Certifications / Licenses:
Driver's License
Licensed Independent Clinical Social Worker
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Salesforce Application Architect

AmeriHealth Caritas
Located in Ohio
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Role Overview We are looking for a passionate and seasoned Salesforce CRM ...
Details
Summary
About the job:
Application Architect who can lead the design and architecture for next-generation Member Engagement capabilities on our Salesforce platform. Reporting to the Director of Member Engagement CRM, the technology leader in this role will provide thought, technology engineering, architecture, delivery and operational leadership for all our lines of businesses. The Application Architect will closely work with Development managers, Lead developers, Enterprise architects to deliver best in class solutions for AmeriHealth...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Computer Systems Engineers/Architects
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

Supervisor Utilization Management Review

AmeriHealth Caritas
Located in Ohio
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Role Overview The Utilization Management Review Supervisor manages a remote ...
Details
Summary
About the job:
team of clinical reviewers. In this role, you will provide clinical, technical, and operational guidance to staff, oversee workflow and inventory, and ensure the team meets its goals through performance monitoring, auditing, coaching, and training. Work Arrangement Remote role. Monday through Friday, 8:00a EST to 5:00p EST Must be able to rotate weekend and evening hours based on business needs Must be able to work 4 recognized company holidays to include Thanksgiving and Christmas (rotating) Responsibilities Team...
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:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Vice President Pharmacy Actuarial

AmeriHealth Caritas
Located in Ohio
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Job Summary The Vice President, Pharmacy Actuarial leads enterprise-wide ...
Details
Summary
About the job:
actuarial strategy and execution for all pharmacy products and services across the organization’s lines of business, including Medicare Part D, Medicaid, MMP/SNP, and Commercial Exchange. This leader is responsible for overseeing pricing, trend analysis, forecasting, CMS bid development, and drug cost management strategies across both pharmacy benefit and pharmacy carve-out populations. The VP partners closely with PBM leaders, clinical pharmacy teams, and finance executives to align actuarial insight with strategic...
Location:
Located in Ohio
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:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Manager Utilization Management Administration Operations & Correspondence

AmeriHealth Caritas
Located in Ohio
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Role Overview Under the supervision of the Director of Utilization ...
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Summary
About the job:
Management Administrative Operations and Audit, this position is responsible for providing daily oversight of the Utilization Management Correspondence team. In this role, you will provide clinical, technical and operational support and direction, including organization and monitoring of all medical services. This role provides oversight of professional and front-line staff, receiving requests for notification of authorization determinations from external customers which encompasses providers and members, as well as from the...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
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
apply
Detailed Job Information

Salesforce Developer Programmer Senior

AmeriHealth Caritas
Located in Ohio
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Role Overview AmeriHealth Caritas is seeking a dynamic Salesforce Developer ...
Details
Summary
About the job:
Senior to join our fast-growing Member Services Salesforce Team. In this role, you will use your ‘can do attitude’, strong Salesforce technical knowledge to deliver and build solutions on AmeriHealth’s Member CRM Salesforce platform. As a team member of Member CRM Team, you will analyze, develop, deliver and triage in the highly challenging and rewarding Healthcare domain and be a critical part of the future of Healthcare IT at AmeriHealth Caritas. Work Arrangement - This is a 100% Remote position but you must live in...
Location:
Located in Ohio
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

Supervisor Utilization Management Review

AmeriHealth Caritas
Located in Ohio
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Role Overview The Utilization Management Review Supervisor manages a remote ...
Details
Summary
About the job:
team of Utilization Management Reviewers. In this role, you will provide clinical, technical, and operational guidance to staff, oversee workflow and inventory, and ensure the team meets its goals through performance monitoring, auditing, coaching, and training. Work Arrangement Remote role. Monday through Friday, 8:00a EST to 5:00p EST Must be able to rotate weekend and evening hours based on business needs Must be able to work 4 recognized company holidays to include Thanksgiving and Christmas (rotating)...
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:
Certified Registered Nurse
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Supervisor Utilization Management Review

AmeriHealth Caritas
Located in Ohio
Actions
Apply
Save to My Profile
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Report this job
Role Overview The Utilization Management Review Supervisor manages a remote ...
Details
Summary
About the job:
team of clinical reviewers. In this role, you will provide clinical, technical, and operational guidance to staff, oversee workflow and inventory, and ensure the team meets its goals through performance monitoring, auditing, coaching, and training. Work Arrangement Remote role. Monday through Friday, 8:00a EST to 5:00p EST Must be able to rotate weekend and evening hours based on business needs Must be able to work 4 recognized company holidays to include Thanksgiving and Christmas (rotating) Responsibilities Team...
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:
Certified Registered Nurse
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Program Integrity Recovery Analyst

AmeriHealth Caritas
Newtown Square, PA
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Role Overview: As part of the Program Integrity recovery team, the Program ...
Details
Summary
About the job:
Integrity Analyst I is responsible for managing overpayment recovery Projects through parts of the lifecycle for larger Projects and through the full lifecycle for smaller Projects. This position will require working closely with ACFC plans and external Program Integrity vendors to ensure that recovery opportunities result in realized recoveries. Complexity and size of recovery Projects are differentiated by analyst level. Work Arrangement: - Hybrid- Associate must be in the office at least three (3) days per week,...
Location:
Newtown Square, PA
Job Type:
Full-Time
Permanent
Occupation:
Management Analysts
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

SVP Quality Health Equity & Risk Adjustment

AmeriHealth Caritas
Located in Ohio
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Role Overview Reporting to the EVP & Chief Medical Officer, the SVP Quality, ...
Details
Summary
About the job:
Health Equity and Risk Adjustment will be broadly responsible for the AmeriHealth Caritas Family of Companies’ (ACFC) Quality and Health Equity Programs, inclusive of performance improvement, across all lines of business and in all geographies and Risk adjustment performance. The role will ensure that the AmeriHealth Family of Companies Health Plans’ executes NCQA, CMS and/or ACA Qualified Health Plan related certification requirements in all of its components: Assurance of compliance to quality, health equity, NCQA,...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
AmeriHealth Caritas
Certifications / Licenses:
National Committee for Quality Assurance
Advanced Certification Administrator
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information
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