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Responsibilities: Responsible for researching, writing, editing and updating ...
Details
Summary
About the job:
member communications to support Plan health education and outreach initiatives. These include print and electronic media (member newsletters, web site content, letters and postcards) and telephonic scripts. Accountable for ensuring that print and electronic communications with members are culturally appropriate and can be easily understood by persons with limited health literacy and limited English proficiency. Independently ensures that these department materials are innovative, clinically accurate and health...
Location:
Columbus, OH
Job Type:
Full-Time
Permanent
Occupation:
Public Relations Specialists
Career Level / Education:
Bachelor's degree
Salary:
High Income Jobs ($80K-$99K)
Certifications / Licenses:
National Committee for Quality Assurance
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
5
Responsibilities: - The Account Executive I is responsible for building, ...
Details
Summary
About the job:
nurturing and maintaining positive working relationships between Plan and its contracted providers. - Assigned provider accounts may include single or multiple practices in single or multiple locations, integrated delivery systems or other provider organizations. - AE I maintains in depth understanding of Plan’s contracts and provider performance and needs, identifying, developing and conducting relevant and tailored provider orientation sessions, making educational visits and working to resolve provider issues. -...
Location:
Toledo, OH
Job Type:
Full-Time
Permanent
Occupation:
Sales Representatives, Services, All Other
Career Level / Education:
High school diploma or equivalent
Salary:
Upper Middle Income Jobs ($50K-$79K)
Certifications / Licenses:
N/A
Workkeys
Applied Math
5
Graphic Literacy
5
Workplace Documents
5
Responsibilities: The Investigator is responsible for conducting ...
Details
Summary
About the job:
comprehensive investigations of reported, alleged or suspected fraud involving the full range of products at the AmeriHealth Caritas Family of Companies (ACFC). Major Accountabilities: - Ensures compliance with all requirements related to Special Investigation Units and fraud, waste and abuse investigations. - Performance of data-mining activities to identify potential cases for investigation. - Performing sampling methodologies for medical record requests/reviews (e.g., OIG SVRS tool, Probe or random sampling). - Conducts...
Location:
Columbus, OH
Job Type:
Full-Time
Permanent
Occupation:
Criminal Investigators and Special Agents
Career Level / Education:
High school diploma or equivalent
Salary:
High Income Jobs ($80K-$99K)
Certifications / Licenses:
Driver's License
Workkeys
Applied Math
3
Graphic Literacy
4
Workplace Documents
4
Responsibilities: - The Account Executive I is responsible for building, ...
Details
Summary
About the job:
nurturing and maintaining positive working relationships between Plan and its contracted providers. - Assigned provider accounts may include single or multiple practices in single or multiple locations, integrated delivery systems or other provider organizations. - AE I maintains in depth understanding of Plan’s contracts and provider performance and needs, identifying, developing and conducting relevant and tailored provider orientation sessions, making educational visits and working to resolve provider issues. -...
Location:
Cleveland, OH
Job Type:
Full-Time
Permanent
Occupation:
Sales Representatives, Services, All Other
Career Level / Education:
High school diploma or equivalent
Salary:
Upper Middle Income Jobs ($50K-$79K)
Certifications / Licenses:
N/A
Workkeys
Applied Math
5
Graphic Literacy
5
Workplace Documents
5
Responsibilities: The Psychologist Advisor (“PA”) is responsible for ...
Details
Summary
About the job:
providing consultation and determinations for clinical cases in need of review. The PA supports the clinical department in applying Medical Necessity Criteria, Appendix T, to render determinations to complaints & grievances for specific levels of care. In addition, the PA will assess clinical aspects of quality of care issues pertaining to best practice standards.. The PA will provide quality monitoring related to the CBHNP Children’s Model. The PA will perform quality improvement activities consistent with qualifications as...
Location:
Columbus, OH
Job Type:
Full-Time
Permanent
Occupation:
Mental Health Counselors
Career Level / Education:
Master's degree
Salary:
Upper Middle Income Jobs ($50K-$79K)
Certifications / Licenses:
National Committee for Quality Assurance
Licensed Psychologist
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
4
Responsibilities: Provide organizational leadership in the operational areas ...
Details
Summary
About the job:
of care management, utilization review, appeals, quality improvement and related policy and practice initiatives in collaboration with the Corporate Medical Director(s), Utilization Management and the Vice President, Utilization Management Physician. The following responsibilities are in regards to enrollees with medical conditions and their providers: - Identifying and implementing evidence-based practice guidelines throughout the provider network. - Overseeing the quality of clinical care for network and...
Location:
Columbus, OH
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
Career Level / Education:
Bachelor's degree
Salary:
High Income Jobs ($80K-$99K)
Certifications / Licenses:
N/A
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
5
Responsibilities: As part of the clinical systems training team, the ...
Details
Summary
About the job:
Clinical Systems Trainer plans, develops and conducts education and training programs for staff necessary to meet the organization’s business objectives, regulatory guidelines and improve skills and professional growth and development. - Assists with training on utilization of Medical Management software platform and applications utilized by Utilization Management and Case Management staff as requested. Maintains a current knowledge base with regard to rules, regulations, policies and procedures relating to the...
Location:
Columbus, OH
Job Type:
Full-Time
Permanent
Occupation:
Training and Development Specialists
Career Level / Education:
Bachelor's degree
Salary:
Middle Income Jobs ($30K-$49K)
Certifications / Licenses:
N/A
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
5
Responsibilities : As part of the Quality Management team, the Senior ...
Details
Summary
About the job:
Quality Performance Specialist – Senior is responsible for the oversight, design, 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. This position is responsible for leading and coordinating the...
Location:
Columbus, OH
Job Type:
Full-Time
Permanent
Occupation:
Clinical Nurse Specialists
Career Level / Education:
Associate's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
National Committee for Quality Assurance
Workkeys
Applied Math
5
Graphic Literacy
4
Workplace Documents
5
Responsibilities: The Clinical Appeals Reviewer reports to an Appeals and ...
Details
Summary
About the job:
Grievances Supervisor and is responsible for processing appeals and grievances ensuring all milestones are within compliance. - Outreaches to the appellant or their representative and is responsible for obtaining and reviewing medical records and packaging all pertinent information into a case for a determination. - Directly interacts with providers to obtain additional clinical information as well as with members or their advocates to understand the full intent of the appeal or grievance. - Throughout the performance...
Location:
Columbus, OH
Job Type:
Full-Time
Permanent
Occupation:
Clinical Nurse Specialists
Career Level / Education:
Associate's degree
Salary:
High Income Jobs ($80K-$99K)
Certifications / Licenses:
Certified Registered Nurse
National Committee for Quality Assurance
Workkeys
Applied Math
5
Graphic Literacy
4
Workplace Documents
5
Responsibilities: As part of the Quality Management team, the Quality ...
Details
Summary
About the job:
Performance Specialist is responsible for the coordination and ongoing monitoring of QI program objectives, including the delivery of performance improvement projects for service and clinical activities, integrating the quality improvement plan into all departments and facilitating HEDIS, CAHPS and NCQA accreditation activities. Implements and supports the overall implementation of quality programs that meet or exceed applicable State, Federal and NCQA standards. Principal Accountabilities: - Executes on organizational...
Location:
Columbus, OH
Job Type:
Full-Time
Permanent
Occupation:
Business Operations Specialists, All Other
Career Level / Education:
High school diploma or equivalent
Salary:
High Income Jobs ($80K-$99K)
Certifications / Licenses:
National Committee for Quality Assurance
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A

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State: OH
Company Name: AmeriHealth Caritas
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