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Results based on filters ( 55 jobs found )

Clinical Care Reviewer Utilization Management

AmeriHealth Caritas
Located in Ohio
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data-type="string"> Description : **Role Overview:** Under the direction of ...
Details
Summary
About the job:
a supervisor, the Clinical Care 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...
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
Driver's License
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

State Government & External Affairs Director - Philadelphia, PA

AmeriHealth Caritas
Philadelphia, PA
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3355822 No 6090 5519 1 21-Feb-2026 Auto req ID 466218BR Company AmeriHealth ...
Details
Summary
About the job:
Caritas Job Code Health-Services health-services Job Description On behalf of VetJobs/MilitarySpouseJobs, thank you for your interest. We are assisting our partnering company, listed below, with this position. It is open to Veterans, Transitioning Military, National Guard Members, Military Spouses, Wounded Warriors, and their Caregivers. If you have the required skill set, education requirements, and experience, please click the submit button and follow for next steps. Under the general direction of the Senior Vice...
Location:
Philadelphia, PA
Job Type:
Full-Time
Permanent
Occupation:
Public Relations Managers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
Military Spouse Corporate Career Network (MSCCN)
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Claims Examiner - Philadelphia, PA

AmeriHealth Caritas
Philadelphia, PA
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3355821 No 6090 5519 1 21-Feb-2026 Auto req ID 466217BR Company AmeriHealth ...
Details
Summary
About the job:
Caritas Job Code Health-Services health-services Job Description On behalf of VetJobs/MilitarySpouseJobs, thank you for your interest. We are assisting our partnering company, listed below, with this position. It is open to Veterans, Transitioning Military, National Guard Members, Military Spouses, Wounded Warriors, and their Caregivers. If you have the required skill set, education requirements, and experience, please click the submit button and follow for next steps. The Claims Examiner reports to the Supervisor of...
Location:
Philadelphia, PA
Job Type:
Full-Time
Permanent
Occupation:
Claims Adjusters, Examiners, and Investigators
Career Level / Education:
High school diploma or equivalent
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
Military Spouse Corporate Career Network (MSCCN)
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Clinical Appeals Reviewer - Philadelphia, PA

AmeriHealth Caritas
Philadelphia, PA
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3355823 No 6090 5519 1 21-Feb-2026 Auto req ID 466219BR Company AmeriHealth ...
Details
Summary
About the job:
Caritas Job Code Health-Services health-services Job Description On behalf of VetJobs/MilitarySpouseJobs, thank you for your interest. We are assisting our partnering company, listed below, with this position. It is open to Veterans, Transitioning Military, National Guard Members, Military Spouses, Wounded Warriors, and their Caregivers. If you have the required skill set, education requirements, and experience, please click the submit button and follow for next steps. The Clinical Appeals Reviewer is responsible for...
Location:
Philadelphia, PA
Job Type:
Full-Time
Permanent
Occupation:
Administrative Law Judges, Adjudicators, and Hearing Officers
Career Level / Education:
Doctoral or professional degree
Salary:
Six Figure Jobs (more than $100K)
From:
Military Spouse Corporate Career Network (MSCCN)
Certifications / Licenses:
National Committee for Quality Assurance
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Appeals & Grievance Case Resolution Spec - Philadelphia, PA

AmeriHealth Caritas
Philadelphia, PA
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3355820 No 6090 5519 1 21-Feb-2026 Auto req ID 466216BR Company AmeriHealth ...
Details
Summary
About the job:
Caritas Job Code Health-Services health-services Job Description On behalf of VetJobs/MilitarySpouseJobs, thank you for your interest. We are assisting our partnering company, listed below, with this position. It is open to Veterans, Transitioning Military, National Guard Members, Military Spouses, Wounded Warriors, and their Caregivers. If you have the required skill set, education requirements, and experience, please click the submit button and follow for next steps. The Appeals & Grievance Case Resolution...
Location:
Philadelphia, PA
Job Type:
Full-Time
Permanent
Occupation:
Healthcare Social Workers
Career Level / Education:
Master's degree
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
Military Spouse Corporate Career Network (MSCCN)
Certifications / Licenses:
National Committee for Quality Assurance
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Appeals & Grievance Case Resolution Spec

AmeriHealth Caritas
Located in Ohio
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data-type="string"> Description : **Job Summary** The Appeals & Grievance ...
Details
Summary
About the job:
Case Resolution Specialist is responsible for the full life cycle of assigned member and/or provider appeals and grievance cases. Working under general supervision, this role conducts case intake, investigation, and documentation to ensure accurate and timely resolution consistent with federal state, and accreditation standards. The Specialist serves as a key liaison between members, providers, and internal departments to resolve issues effectively, ensuring the integrity of the appeals and grievance process and...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Patient Representatives
Career Level / Education:
Postsecondary nondegree award
Salary:
Middle Income Jobs ($30K-$49K)
From:
De jobs
Certifications / Licenses:
National Committee for Quality Assurance
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

UAT Test Validation Analyst II

AmeriHealth Caritas
Located in Ohio
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Role Overview Under the direction of the UAT Team Lead, the UAT Test ...
Details
Summary
About the job:
Validation Analyst II executes comprehensive functional and regression test plans in support of system changes. This includes supporting or leading testing for all projects and required changes impacting systems from beginning to end. Work Arrangement This is a 100% Remote Position Responsibilities Participation in the development of business requirements and analyzing requirements to determine testing scope Creation of test approach documentation including scripts Successfully execute test cases and analyze results to...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Software Quality Assurance Analysts and Testers
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

Personal 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:
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

Corporate Provider Network Account Executive

AmeriHealth Caritas
Located in Ohio
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data-type="string"> Description : **Role Overview:** The Corporate Provider ...
Details
Summary
About the job:
Network Management Account Executive plays a critical role in developing high-performing provider networks that meet state and Centers for Medicare & Medicaid Services (CMS) requirements for new and expanding markets. In this dynamic and fast-paced role, you will identify and recruit key providers, negotiate contracts, and establish trusted partnerships with healthcare professionals and organizations at a rapid pace. You will also contribute to the strategic direction of network development by creating business plans,...
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:
Driver's License
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
Actions
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data-type="string"> Description : Your career starts now. We are looking for ...
Details
Summary
About the job:
the next generation of health 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...
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:
De jobs
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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