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Results based on filters ( 55 jobs found )

Manager Medical Economics & Business Process

AmeriHealth Caritas
Located in Ohio
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data-type="string"> Description : **Role Overview** : The Manager, Medical ...
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About the job:
Economics & Business Process leads a team responsible for delivering healthcare data and medical economics analyses across a variety of data sources, including claims, authorizations, member, and provider data. This role partners closely with cross‑functional teams to structure and execute analyses, generate insights, and identify opportunities to improve medical costs, operational performance, and overall business outcomes. This is a hands-on role, which combines team leadership with active analytic contributions 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 Provider Network

AmeriHealth Caritas
Dublin, OH
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**Role Overview:** The Coordinator of Provider Network supports the Provider ...
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About the job:
Network Operations team in managing Plan operational functions and activities.**Key Responsibilities Include:**+ Coordinates and facilitates administrative activities, including meetings and material development (P&Ps, desk procedures, workflows, etc.).+ Performs provider AGID assignment/submissions to Enterprise Operations (EO).+ Performs provider roster analysis/management (adds, changes, terms) and subsequent submissions to EO for update.+ Coordinates and submits panel transfers.+ Performs other related duties and...
Location:
Dublin, OH
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
Career Level / Education:
Bachelor's degree
Salary:
High Income Jobs ($80K-$99K)
From:
US.jobs
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
Washington, DC
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$5,000.00 SIGN ON BONUS Role Overview Our Utilization Management Reviewers ...
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Summary
About the job:
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 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. When necessary, cases are...
Location:
Washington, DC
Job Type:
Full-Time
Permanent
Occupation:
Registered Nurses
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
AmeriHealth Caritas
Certifications / Licenses:
Associate of Science in Nursing
Certified Registered Nurse
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Enterprise Growth Analytics Manger

AmeriHealth Caritas
Located in Ohio
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data-type="string"> Description : **Job Summary** The Manager, Enterprise ...
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Summary
About the job:
Growth Analytics serves a pivotal role within the Growth and Analytics department, driving innovative analytics initiatives to support growth for Medicaid and other AmeriHealth Caritas products. Reporting directly to the Director of Enterprise Growth Analytics, this position is responsible for the development, maintenance, and enhancement of Data Parades across multiple states to ensure readiness for state procurements and re-procurements. In addition, this role will support the Enterprise by providing comprehensive...
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

Clinical Appeals Reviewer

AmeriHealth Caritas
Located in Ohio
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data-type="string"> Description : **Role Overview:** The Clinical Appeals ...
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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. **Responsibilities:** + Process appeals, ensuring compliance with...
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

Utilization Management Reviewer

AmeriHealth Caritas
Washington
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data-type="string"> Description : **$5,000.00 SIGN ON BONUS** **Role ...
Details
Summary
About the job:
Overview** Our Utilization Management Reviewers 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 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...
Location:
Washington
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

Healthcare Interoperability Business Systems Analyst Lead

AmeriHealth Caritas
Located in Ohio
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data-type="string"> Description : **Role Overview** The Lead Business ...
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About the job:
Systems Analyst leads business analysis and data exchange initiatives in the Data Integration Department within our Enterprise Data Office, with a strong focus on HL7 standards (FHIR, CCD, ADT, SIU) to ensure regulatory compliance (CMS, ONC) and data integrity. The position requires deep healthcare data expertise and the ability to independently drive requirements, translate business needs into technical specifications, partner closely with IT teams, and mentor junior Business Analysts. **Work Arrangement** + This is 100%...
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:
ICD-10 / ICD-9
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Manager, Provider Network Operations

AmeriHealth Caritas
Southfield, MI
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Role Overview: The Manager of Provider Network Operations is responsible for ...
Details
Summary
About the job:
overseeing Michigan Blue Cross Complete provider inquiries and complaints. Work Arrangement: - Remote - The associate can work remotely from anywhere in the Detroit Metro area, Michigan (MI), and must be able to attend monthly leadership meetings at our Southfield, MI, location. Responsibilities: - Manages the day-to-day activities of the Provider Network Operations department and supervises, directs, monitors, reviews, and coaches staff and their work performance - Oversees and manages the timeliness and other...
Location:
Southfield, MI
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:
State of Michigan
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Summer Intern (Graduate Level, Computer Science)

AmeriHealth Caritas
Located in Ohio
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data-type="string"> Description : AmeriHealth Caritas Family of Companies ...
Details
Summary
About the job:
offers paid summer internships to students enrolled in full time undergraduate or graduate degree programs. The AmeriHealth Caritas Summer Internship Program provides students with the opportunity to gain meaningful professional experience while learning about the healthcare industry and the work we do to improve access to care and support healthier communities. Interns will work closely with a designated manager and mentor to contribute to real team initiatives and complete a defined project aligned with departmental...
Location:
Located in Ohio
Job Type:
Full-Time
Internship
Occupation:
Data Scientists
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
De jobs
Certifications / Licenses:
Azure Certification
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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data-type="string"> Description : Your career starts now. We’re looking for ...
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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:
Customer Service Representatives
Career Level / Education:
High school diploma or equivalent
Salary:
Upper Middle Income Jobs ($50K-$79K)
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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