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Results based on filters ( 61 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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Summary
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

Healthcare Payer Director EPMO

AmeriHealth Caritas
Located in Ohio
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data-type="string"> Description : **Role Overview** The **Director, ...
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About the job:
Enterprise Project Management Office (EPMO)** will be a pivotal leader within the organization, responsible for managing a portfolio of **Medicaid / Medicare Growth Initiatives** projects, leading a team of project managers and supporting resources including business analysts, and leading key strategic initiatives, ensuring effective execution of complex product development, capability implementation, and process improvement initiatives. Specific responsibilities of the role include the management of a portfolio in a manner...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Project Management Specialists
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
De jobs
Certifications / Licenses:
Enterprise Project Management
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Plan Analytics Analyst

AmeriHealth Caritas
Located in Ohio
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data-type="string"> Description : **Role Overview:** The Plan Analytics ...
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Summary
About the job:
Analyst advances data-driven decision-making across the organization by partnering with leadership and serving as a trusted source for data, reporting, and insights. Through comprehensive analysis, this role delivers clear, actionable recommendations that inform organizational strategy and build strong partnerships, while consistently delivering high-quality outcomes and effective solutions. **Work Arrangements:** + Remote - This position is fully remote and may be performed from any location within the United States;...
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:
De jobs
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Senior Plan Analytics Analyst

AmeriHealth Caritas
Located in Ohio
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data-type="string"> Description : **Role Overview:** The Senior Plan ...
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About the job:
Analytics Analyst leads complex analytical work, builds strong relationships across multiple levels of the organization to drive adoption of data- and insights-driven decision-making, serves as a key partner to leadership, supporting strategic vision and goals, and acts as a trusted resource for data, reporting, and delivering clear actionable insight. **Work Arrangements:** + Remote - This position is fully remote and may be performed from any location within the United States; however, the associate is required to work...
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

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 ...
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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

Correspondence Quality & Compliance Specialist

AmeriHealth Caritas
Located in Ohio
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data-type="string"> Description : **Role Overview** As a member of the ...
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About the job:
Utilization Management Administrative Operations team, you will manage the UM letter approval process across the enterprise to include Medicare, Medicaid, CHIP, Exchange, and Behavioral Health. You will interface with internal teams and UM delegates to conduct quality reviews of UM letters templates and edit them as required to ensure adherence with NCQA and contractual requirements. **Work Arrangement** + Remote role + Monday through Friday, 8:00 AM EST to 5:00 PM EST **Responsibilities** + Acts as primary point of...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Healthcare Social Workers
Career Level / Education:
Master's degree
Salary:
High Income Jobs ($80K-$99K)
From:
De jobs
Certifications / Licenses:
Licensed Clinical Social Worker
National Committee for Quality Assurance
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Senior Clinical Quality Perform Specialist

AmeriHealth Caritas
Located in Ohio
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data-type="string"> Description : **Role Overview:** The Senior Clinical ...
Details
Summary
About the job:
Quality Performance Specialist is responsible for overseeing, designing, and implementing quality initiatives, identifying root causes, establishing and executing work plans to implement effective interventions. The position is grounded in data analytics skills in order to work collaboratively with providers, members, and internal departments across the organization to conduct ongoing processes that identify opportunities for quality, service, and clinical improvement. Manages activities related to plan accreditation,...
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
Certified Registered Nurse
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Home Modification Specialist

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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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:
Healthcare Social Workers
Career Level / Education:
Master's degree
Salary:
High Income Jobs ($80K-$99K)
From:
De jobs
Certifications / Licenses:
Driver's License
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, DC
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$5,000.00 SIGN ON BONUS Role Overview Our Utilization Management Reviewers ...
Details
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
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