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Results based on filters ( 55 jobs found )

Quality Perform Specialist Sr Clinical

AmeriHealth Caritas
Located in Ohio
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data-type="string"> Description : **Responsibilities:** The Senior Quality ...
Details
Summary
About the job:
Performance Specialist – Clinical is responsible for taking on responsibilities that support the day-to-day operations.and implementation of Quality projects ensuring identification of root cause, and with the assistance of the Quality Director establishes a work plan to implement interventions This position will work in a collaborative manner with all providers, members, departments within AmeriHealth Caritas to conduct ongoing process and data review to identify opportunities for improvement. The position will manage...
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
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Manager Quality Management

AmeriHealth Caritas
Located in Ohio
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data-type="string"> Description : Your career starts now. We’re looking for ...
Details
Summary
About the job:
the next generation of health care 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...
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:
National Committee for Quality Assurance
Driver's License
Certified Professional in Healthcare Quality
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Long Term Services & Support Utilization Management Correspondence RN

AmeriHealth Caritas
Located in Ohio
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data-type="string"> Description : Your career starts now. We’re 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 nation’s leaders in health care solutions, we offer our associates the opportunity to impact millions of lives through our national footprint of products, services, and award-winning programs. Headquarters in Newtown Square, AmeriHealth Caritas is a mission-driven organization with over 30 years of experience. We deliver comprehensive,...
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
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Implementation Lead

AmeriHealth Caritas
Located in Ohio
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data-type="string"> Description : Your career starts now. We’re looking for ...
Details
Summary
About the job:
the next generation of healthcare 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...
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:
De jobs
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Coordinator Credentialing Delegation Oversight

AmeriHealth Caritas
Located in Ohio
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data-type="string"> Description : **Role Overview** As a member of the ...
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Summary
About the job:
Corporate Credentialing team, the Delegation Oversight Coordinator will interface with delegated provider groups, complete required auditing and reporting related to provider delegation, and ensure adherence with NCQA, and /or state, federal, and business requirements. Serve as a key contact for communications and ensure compliance with performance metrics. **Responsibilities** + Conduct pre-delegation, annual and corrective action oversight audits + Continuous monitoring of master spreadsheet of all delegates to ensure...
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:
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

Strategic Communications Director

AmeriHealth Caritas
Located in Ohio
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data-type="string"> Description : **Role Overview:** The Strategic ...
Details
Summary
About the job:
Communications Director is responsible for leading the development, implementation, and execution of communications strategy to showcase ACFC’s reputation and transformative advocacy at a state and federal level. This role connects thought leadership, policy positioning, and community partnerships to translate complex issues into clear, accessible, and persuasive messaging using storytelling for diverse audiences, including internal and external stakeholders, as well as the general public. The Strategic Communications Director...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Public Relations Managers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
De jobs
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Special Investigator-Health Insurance Fraud (Ohio residency required)

AmeriHealth Caritas
Located in Ohio
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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. **This position is remote however, you must live and be able to travel within Ohio as business needs.** 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,...
Location:
Located in Ohio
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:
De jobs
Certifications / Licenses:
Driver's License
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Clinical Appeals Reviewer

AmeriHealth Caritas
Located in Ohio
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data-type="string"> Description : **Role Overview:** The Clinical Appeals ...
Details
Summary
About the job:
Reviewer is responsible for processing appeals and ensuring all milestones are met in compliance with regulatory requirements. This role involves outreach to appellants or their representatives, obtaining and reviewing medical records, packaging pertinent information into a case for determination, interacting directly with providers to obtain additional clinical information, and with members or their advocates to understand the full intent of the appeal. **Work Arrangement:** Works Monday - Friday 8:30 - 5:00 p.m....
Location:
Located in Ohio
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:
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

Operations Quality Auditor-Provider Enrollment Services Audit

AmeriHealth Caritas
Located in Ohio
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data-type="string"> Description : Your career starts now. We're looking for ...
Details
Summary
About the job:
the next generation of health care 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...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
First-Line Supervisors of Office and Administrative Support Workers
Career Level / Education:
High school diploma or equivalent
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

Healthcare Enterprise Analytics Outcomes Specialist

AmeriHealth Caritas
Located in Ohio
Actions
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data-type="string"> Description : **Role Overview** Under the leadership of ...
Details
Summary
About the job:
the Manager Outcomes Evaluation – Business Insights, the **Enterprise Analytics Outcomes Specialist** is responsible for sharing insights in a way that is easy to grasp and actionable, building relationships to help drive adoption of data- and insights-driven decision making across a variety of subject matters including, but not limited to Medicare, medical and quality management, authorizations, claims, SIU, statutory/regulatory, non-HEDIS, Jiva/eLTSS and population health. and goals. This role requires a highly...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Statisticians
Career Level / Education:
Master'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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