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Medical Economics Solutions Director

AmeriHealth Caritas
Located in Ohio
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Job Ref: 43733 Employer: AmeriHealth Caritas Sector: Health Insurance ...
Details
Summary
About the job:
Qualifications: Senior Qualified Actuary Software: Excel SQL Tableau Job Type: Full Time Salary and Benefits: Competitive Remote: Yes Location Country: United States Post Code: Not specified Map: ( Show on map ) Description Role Overview The Medical Economics Solutions Director works closely with the VP of Medical Economics and BI to drive progress on projects that support the strategic initiatives of the organization. Work Arrangement - This is a 100% Remote position but you must live in EST or CST times zones...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Management Analysts
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
ProActuary
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Provider Network Operations Data Analyst

AmeriHealth Caritas
Detroit, MI
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Role Overview: The Provider Network Operations Data Analyst plays a key role ...
Details
Summary
About the job:
in maintaining accurate provider data and fostering strong relationships between the health plan and its contracted and non-contracted providers across Medicaid, Medicare, and Exchange products. This role ensures provider information is correctly represented in all operating systems and serves as a proactive liaison to resolve provider-related issues efficiently. Work Arrangement: - Remote – The associate can work remotely from anywhere in the Detroit Metro area, Michigan, and must be able to attend two weeks of...
Location:
Detroit, MI
Job Type:
Full-Time
Permanent
Occupation:
Business Operations Specialists, All Other
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

Market President, New Hampshire

AmeriHealth Caritas
New Hampshire
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Your career starts now. We’re looking for the next generation of health care ...
Details
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:
New Hampshire
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:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Care Connector

AmeriHealth Caritas
Located in Ohio
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Your career starts now. We’re looking for the next generation of health care ...
Details
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:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Healthcare Support Workers, All Other
Career Level / Education:
High school diploma or equivalent
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
AmeriHealth Caritas
Certifications / Licenses:
Certified Personal Trainer
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

RN CARE MANAGER

AmeriHealth Caritas
Columbia, SC
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Role Overview: The Care Manager (BSN - RN) 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) is responsible for engaging the member, member care giver 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 Manager...
Location:
Columbia, SC
Job Type:
Full-Time
Permanent
Occupation:
Registered Nurses
Career Level / Education:
Bachelor's degree
Salary:
High Income Jobs ($80K-$99K)
From:
AmeriHealth Caritas
Certifications / Licenses:
Certified Registered Nurse
National Committee for Quality Assurance
Driver's License
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Provider Network Data Oversight Analyst

AmeriHealth Caritas
Newtown Square, PA
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Your career starts now. We’re looking for the next generation of health care ...
Details
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:
Newtown Square, PA
Job Type:
Full-Time
Permanent
Occupation:
Business Intelligence 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

Utilization Management Reviewer

AmeriHealth Caritas
Located in Ohio
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Role Overview: Under the direction of a supervisor, the Clinical Care ...
Details
Summary
About the job:
Reviewer – Utilization Management evaluates 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....
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:
Certified Registered Nurse
Driver's License
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

RN CARE MANAGER

AmeriHealth Caritas
Located in Ohio
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data-type="string"> Description : **Role Overview:** The Care Manager (BSN - ...
Details
Summary
About the job:
RN) assists members appropriate for care management and care coordination services in achieving their optimal level of health through self-management. The Care Manager (RN) is responsible for engaging the member, member care giver 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...
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:
De jobs
Certifications / Licenses:
Certified Registered Nurse
National Committee for Quality Assurance
Driver's License
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Supervisor Home Modification Specialist

AmeriHealth Caritas
Located in Ohio
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Your career starts now. We’re looking for the next generation of health care ...
Details
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:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Compliance Officers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
AmeriHealth Caritas
Certifications / Licenses:
Driver's License
National Committee for Quality Assurance
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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Job Ref: 43724 Employer: AmeriHealth Caritas Sector: Health Insurance ...
Details
Summary
About the job:
Qualifications: Part Qualified Actuary Software: Access Excel SAS Job Type: Full Time Salary and Benefits: Competitive Remote: No Location Country: United States State/Province/County: Pennsylvania - PA City: Newtown Square Post Code: Not specified Map: ( Show on map ) Description This role is hybrid and requires 3 days/week in the office in Newtown Square, PA. Responsibilities - Calculates, monitors and assesses impact of benefit and provider reimbursement changes, cost containment programs, on medical cost and trends. -...
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:
ProActuary
Certifications / Licenses:
Actuarial Exams
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information
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