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Results based on filters ( 103 jobs found )

MCO Payment Integrity Vendor Manager

AmeriHealth Caritas
Located in Ohio
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Role Overview The Vendor/Client Management Manager assists the organization ...
Details
Summary
About the job:
in getting the best value from Population Health and Payment Integrity vendors while minimizing risk, streamlining processes, reducing costs, increase efficiency, and improving the quality of services provided. The position of Vendor/Client Management Manager is accountable for supporting and maintaining relationships with AmeriHealth Caritas Family of Companies (ACFC) lines of business (LOB), and vendors supporting the Population Health commitments to programmatic clinical outcomes and operational efficiencies. Work...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Project Management Specialists
Career Level / Education:
Bachelor's degree
Salary:
High Income Jobs ($80K-$99K)
From:
AmeriHealth Caritas
Certifications / Licenses:
Cadastral Mapping Specialist
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Provider Network Management Contractor

AmeriHealth Caritas
Southfield, MI
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Role Overview: The Provider Network Management Contractor is responsible for ...
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Summary
About the job:
developing, contracting, and maintaining provider relationships within an assigned market. This role ensures the network is competitive, compliant, and aligned with organizational strategy. Work Arrangement: - Hybrid - Associate must be in the office at least three (3) days per week at our Southfield, Michigan (MI) location, including core days of Tuesdays and Wednesdays Responsibilities: - Supports overall network development strategy. - Assists departmental leadership with provider satisfaction, education, and...
Location:
Southfield, 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:
National Committee for Quality Assurance
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Behavioral Health Care Manager

AmeriHealth Caritas
Located in Ohio
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Role Overview PerformCare-PA Behavioral Health Care Managers are committed ...
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Summary
About the job:
to providing high quality, reliable, and cost-effective behavioral health management services to our members. The PerformCare-PA Behavioral Health Care Manager is responsible for utilization and case management of members with mental health and substance use disorders. In this role, you will coordinate the behavioral healthcare for your assigned caseload in collaboration with the member/family, behavioral and medical providers, behavioral health service systems, physical health managed care organization, when...
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 marriage and family therapist
Licensed Social Worker
Licensed Clinical Social Worker
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

After Hours Utilization Management Reviewer

AmeriHealth Caritas
Located in Ohio
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Role Overview: The After Hours Utilization Management Reviewer is scheduled ...
Details
Summary
About the job:
to work non-traditional hours to provide access to medical necessity determinations for urgent or required coverage requests on a 24/7, 365 basis. This position is required to cover nights, weekends and holidays. Under the direction of a supervisor, you will evaluate 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...
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:
Driver's License
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Network Report Analyst 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:
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

Service Coordinator-CHC

AmeriHealth Caritas
Allentown, PA
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Role Overview As a Service Coordinator, you will assist participants who ...
Details
Summary
About the job:
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, coordinate, and manage participant's needs, including physical health, behavioral health, social services, and long-term services and support, as well as telephonic follow-up. Work Arrangement Remote Candidates must live in and be able to travel to Lehigh and Northampton...
Location:
Allentown, 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

Credentialing Specialist

AmeriHealth Caritas
Located in Ohio
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Role Overview The Credentialing Specialist is responsible for managing ...
Details
Summary
About the job:
credentialing and re-credentialing processes for all providers in compliance with NCQA, state, and federal regulations. Key Responsibilities - Validate completeness of provider applications prior to processing. - Perform primary source verification for credentialing and re-credentialing applications. - Monitor site visit progress and ensure completion within established timeframes. - Accurately enter provider application data into the credentialing system. - Respond to inquiries from internal and external clients via the...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Human Resources Specialists
Career Level / Education:
Bachelor's degree
Salary:
High Income Jobs ($80K-$99K)
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

Business Analyst Vendor Management

AmeriHealth Caritas
Located in Ohio
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The Vendor Management Business Analyst develops solutions to business ...
Details
Summary
About the job:
problems and opportunities. Solutions may consist of process improvement as well as system development components. The Vendor Management Business Analyst works as a liaison among Vendors and Stakeholders in order to Elicit, Analyze, Communicate and Validate Requirements for changes to business processes, policies and information systems. The Analyst is the primary contact for Vendor related claims issues. The individual understands business problems and opportunities in the context of the “requirements” and recommends...
Location:
Located in Ohio
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

Network Contractor Provider Network Management - Exchange product

AmeriHealth Caritas
Baton Rouge, LA
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Job Summary The primary responsibility of the Network Contractor is ...
Details
Summary
About the job:
contracting providers, the contracting and re-contracting of providers in an established market. Work Arrangement: Field based within Louisiana. May live anywhere within the state of Louisiana. Some travel required throughout the state visiting providers. Essential Functions - Supports network development strategy. - Responsible for assisting the Leader with departmental activities related to provider satisfaction, education, and communication. - Responsible for negotiating contracts to execute on network strategy and ensure...
Location:
Baton Rouge, LA
Job Type:
Full-Time
Permanent
Occupation:
Business Operations Specialists, All Other
Career Level / Education:
Bachelor's degree
Salary:
Upper Middle Income Jobs ($50K-$79K)
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

Service Coordinator-CHC

AmeriHealth Caritas
York, PA
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Role Overview As a Service Coordinator, you will assist participants who ...
Details
Summary
About the job:
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, coordinate, and manage participant's needs, including physical health, behavioral health, social services, and long-term services and support, as well as telephonic follow-up. Work Arrangement Remote Qualified candidates must live in and be able to travel to York and...
Location:
York, 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
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