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Results based on filters ( 145 jobs found )

Medicaid Markets Associate Actuary

AmeriHealth Caritas
Newtown Square, PA
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Responsibilities: The Associate Actuary will collaborate with team members ...
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Summary
About the job:
and other stakeholders toward delivering needed actuarial services to the organization. This position will support Medicaid Markets. Work Arrangement This is a 100% Remote position but you must live in EST or CST time zones Responsibilities - Provides support for rate advocacy by managing databooks and rate mirroring, rate models, MCO surveys, and other requests - Projects and plans for quarterly forecasts utilizing financial forecast models for assigned lines of business - Updates forecasting models for reforecasts...
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:
Associate of the Society of Actuaries
Associate of the Conference of Consulting Actuaries
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Provider Reimbursement Policy Specialist Sr

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:
Medical Records Specialists
Career Level / Education:
Postsecondary nondegree award
Salary:
High Income Jobs ($80K-$99K)
From:
AmeriHealth Caritas
Certifications / Licenses:
Certified Professional Coder
ICD-10 / ICD-9
Registered Health Information Administrator
Certified Coding Specialist
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Service Coordinator-CHC

AmeriHealth Caritas
Scranton, PA
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Role Overview AmeriHealth Caritas is seeking service-oriented, compassionate ...
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Summary
About the job:
healthcare professionals to join our Long Term Services and Support (LTSS) team. Ideal candidates will have experience assessing those needing personal care services for instrumental daily living activities. As a Service Coordinator, you will assist participants who qualify for Medicaid in obtaining the long-term services and support they need as required by the Community Health Choices (CHC) agreement. You will contribute to the care coordination process by performing face-to-face assessments to identify, evaluate,...
Location:
Scranton, PA
Job Type:
Full-Time
Permanent
Occupation:
Social and Human Service Assistants
Career Level / Education:
High school diploma or equivalent
Salary:
Upper Middle Income Jobs ($50K-$79K)
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

Behavioral Health Utilization Management Reviewer

AmeriHealth Caritas
Located in Ohio
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Role Overview: Under the direction of the Supervisor, the Behavioral Health ...
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Summary
About the job:
Utilization Management Reviewer is responsible for completing medical necessity reviews. Using 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. It is within the BH UM Reviewer’s discretion to retain requests for additional information and/or request clarification. The BH UM Reviewer will use his/her professional judgment to...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Healthcare Social Workers
Career Level / Education:
Master's degree
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
AmeriHealth Caritas
Certifications / Licenses:
Licensed Clinical Social Worker
Licensed Independent Clinical Social Worker
Licensed Social Worker
Licensed Master Social Worker
Licensed marriage and family therapist
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Project Management Methodology Consultant

AmeriHealth Caritas
Located in Ohio
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Role Overview The Project Management Methodology Consultant serves as an ...
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Summary
About the job:
internal consultant responsible for ensuring that project teams adhere to a formalized and standardized methodology. They are responsible for maintaining, updating and communicating System Development Life Cycle (SDLC) and methodology best practices across the organization. They recommend and help implement best practices and processes across the organization, ensuring that obstacles and barriers to success are removed. Work Arrangement - This is a 100% Remote but it's preferred you in EST or CST time zones...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Project Management Specialists
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
AmeriHealth Caritas
Certifications / Licenses:
Project Management Professional
Certified Service Manager
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Utilization Management Technician

AmeriHealth Caritas
Located in Ohio
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Your career starts now. We are looking for the next generation of health ...
Details
Summary
About the job:
care leaders. At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities. As one of the nations 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 would like to...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
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

Service Coordinator-CHC

AmeriHealth Caritas
Lancaster, PA
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Role Overview AmeriHealth Caritas is seeking service-oriented, compassionate ...
Details
Summary
About the job:
healthcare professionals to join our Long Term Services and Support (LTSS) team. Ideal candidates will have experience assessing those needing personal care services for instrumental daily living activities. As a Service Coordinator, you will assist participants who qualify for Medicaid in obtaining the long-term services and support they need as required by the Community Health Choices (CHC) agreement. You will contribute to the care coordination process by performing face-to-face assessments to identify, evaluate,...
Location:
Lancaster, PA
Job Type:
Full-Time
Permanent
Occupation:
Social and Human Service Assistants
Career Level / Education:
High school diploma or equivalent
Salary:
Upper Middle Income Jobs ($50K-$79K)
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

Supervisor Appeals & Grievances

AmeriHealth Caritas
Located in Ohio
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Role Overview: Under the direction of the Manager, Appeals & Grievances, the ...
Details
Summary
About the job:
Supervisor will oversee the appeal intake and grievance processes, ensuring compliance with all State and other mandated guidelines. The supervisor will inform appropriate staff of company policy, initiative requirements, and recommendations and ensure proper implementation. They will coordinate with other departments, such as clinical, account executives, and member services staff, regarding appeal and grievance-related activities. The supervisor will produce statutory reports related to appeals and grievances. Work...
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
National Committee for Quality Assurance
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Provider Network Operations Analyst Senior

AmeriHealth Caritas
Located in Ohio
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The Provider Network Operations Analyst Senior is to be responsible for the ...
Details
Summary
About the job:
maintaining current provider data and provider reimbursement set up, and to address provider/state inquiries as it relates to claim payment issues. Work Arrangement: Remote with required hours 8am-5pm Eastern Time Responsibilities: 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...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Medical Records Specialists
Career Level / Education:
Postsecondary nondegree award
Salary:
High Income Jobs ($80K-$99K)
From:
AmeriHealth Caritas
Certifications / Licenses:
Certified Radiology Coder
Certified Rehabilitation Counselor
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Pediatric Care Manager

AmeriHealth Caritas
Washington
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data-type="string"> Description : **Role Overview** The Care Manager ...
Details
Summary
About the job:
(RN/LICSW) assists members appropriate for 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...
Location:
Washington
Job Type:
Full-Time
Permanent
Occupation:
Healthcare Social Workers
Career Level / Education:
Master's degree
Salary:
Six Figure Jobs (more than $100K)
From:
De jobs
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
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