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Provider Network Operations Data Analyst

AmeriHealth Caritas
Detroit, MI
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Role Overview: The Provider Network Operations Data Analyst plays a key role ...
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Summary
About the job:
in maintaining accurate provider data and fostering strong relationships between the health plan and its contracted and non-contracted providers across Medicaid, Medicare, and Exchange products. This role ensures provider information is correctly represented in all operating systems and serves as a proactive liaison to resolve provider-related issues efficiently. Work Arrangement: - Remote – The associate can work remotely from anywhere in the Detroit Metro area, Michigan, and must be able to attend two weeks of...
Location:
Detroit, 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:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Market President, New Hampshire

AmeriHealth Caritas
New Hampshire
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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:
New Hampshire
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:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

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:
Healthcare Support Workers, All Other
Career Level / Education:
High school diploma or equivalent
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
AmeriHealth Caritas
Certifications / Licenses:
Certified Personal Trainer
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

RN CARE MANAGER

AmeriHealth Caritas
Columbia, SC
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Role Overview: The Care Manager (BSN - RN) assists members appropriate for ...
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Summary
About the job:
care management and care coordination services in achieving their optimal level of health through self-management. The Care Manager (RN) is responsible for engaging the member, member care giver 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 management program. In addition, the Care Manager...
Location:
Columbia, SC
Job Type:
Full-Time
Permanent
Occupation:
Registered Nurses
Career Level / Education:
Bachelor's degree
Salary:
High Income Jobs ($80K-$99K)
From:
AmeriHealth Caritas
Certifications / Licenses:
Certified Registered Nurse
National Committee for Quality Assurance
Driver's License
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Provider Network Data Oversight Analyst

AmeriHealth Caritas
Newtown Square, PA
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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:
Newtown Square, PA
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

Utilization Management Reviewer

AmeriHealth Caritas
Located in Ohio
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Role Overview: Under the direction of a supervisor, the Clinical Care ...
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Summary
About the job:
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 ensures compliance with medical policies....
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
Driver's License
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Actuarial Analyst

AmeriHealth Caritas
Newtown Square, PA
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Job Ref: 43725 Employer: AmeriHealth Caritas Sector: Health Insurance ...
Details
Summary
About the job:
Qualifications: Part Qualified Actuary Software: Access Excel SAS Job Type: Full Time Salary and Benefits: Competitive Remote: No Location Country: United States State/Province/County: Pennsylvania - PA City: Newtown Square Post Code: Not specified Map: ( Show on map ) Description This role is hybrid and requires 3 days/week in the office in Newtown Square, PA. Responsibilities - Calculates, monitors and assesses impact of benefit and provider reimbursement changes, cost containment programs, on medical cost and trends. -...
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:
ProActuary
Certifications / Licenses:
Actuarial Exams
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Actuarial Analyst

Amerihealth Caritas Health Plan
Newtown Square, PA
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Job Ref: 43724 Employer: AmeriHealth Caritas Health Plan Sector: Health ...
Details
Summary
About the job:
Insurance Qualifications: Part Qualified Actuary Software: Excel Access SAS Job Type: Full Time Salary and Benefits: Competitive Remote: No Location Country: United States State/Province/County: Pennsylvania - PA City: Newtown Square Post Code: Not specified Map: ( Show on map ) Description This role is hybrid and requires 3 days/week in the office in Newtown Square, PA. Responsibilities - Calculates, monitors and assesses impact of benefit and provider reimbursement changes, cost containment programs, on medical cost and...
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:
ProActuary
Certifications / Licenses:
Actuarial Exams
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

MCO Director Enterprise Portfolio

AmeriHealth Caritas
Located in Ohio
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data-type="string"> Description : **Role Overview** The **Director ...
Details
Summary
About the job:
Enterprise Portfolio** will be responsible for leading the strategy, design, planning, and execution required to successfully govern, oversee, and realize value from the strategic investment portfolio in alignment with our long- and short-term strategic goals. The Director will report to the Vice President of Business Excellence, overseeing a team of manager, senior analysts, and analysts with expertise in enterprise investment portfolio management. The Director will be a trusted advisor, engaging with the most senior-level...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Computer and Information Systems 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

Financial Analyst

AmeriHealth Caritas
Located in Ohio
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data-type="string"> Description : **Role Overview:** ;The Financial Analyst ...
Details
Summary
About the job:
II plays a key role in compiling, analyzing, and interpreting financial data to support the organization’s strategic and operational goals. This position supports enterprise-wide financial analysis efforts and serves as a liaison between functional area management and financial data. The Analyst regularly interacts with employees across all levels of the organization, as well as external clients and vendors, ensuring accurate and insightful financial reporting and collaboration. **Work Arrangement:** + **Hybrid** -...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Financial and Investment 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
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