AmeriHealth Caritas Jobs

AmeriHealth Caritas

COLUMBIA, SC | 7200 followers

AmeriHealth Caritas Overview

WEBSITE amerihealthcaritas.com

HEADQUARTERS COLUMBIA, SC

SIZE 3,000 - 7,500

FOUNDED 1983

REVENUE $5B - $10B

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About AmeriHealth Caritas

At AmeriHealth Caritas, were passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in health care solutions, we impact the lives of millions of people through our national footprint of products, services, and award-winning programs. Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 35 years of experience delivering comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, ...behavioral health services, and other support services. In the process, we are dedicated to helping find solutions to end poverty so the American Dream is in reach for all. More
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Director Provider Network Operations at AmeriHealth Caritas

Charleston, SC | Full Time

$171k-226k (estimate)

2 Days Ago

Job summary. The primary purpose of the job is to be responsible for the oversight of the local Plan’s Provider data, reimbursement rules, and address provider inquiries and complaints. In addition, this position will work in conjunction with the Enterprise Claims Department to ensure all contractual claim requirements are met with quality and consistency. Work Arrangement. This position is remote based within the state of South Carolina. Hire wi...

MCO Director Payment Integrity at AmeriHealth Caritas

Newtown, PA | Full Time

$169k-223k (estimate)

4 Days Ago

Role Overview. The. Director of Payment Integrity Solutions. is responsible for overseeing Payment Integrity edit and program strategy and performance across all ACFC lines of business and products (Medicaid, Medicare, Exchange, PBM, BH). This role ensures that implemented solutions deliver measurable value through rigorous analytics, including the use of artificial intelligence (AI), machine learning (ML), and NLP-based automation, coupled with ...

Manager Healthcare Value Optimization at AmeriHealth Caritas

Newtown, PA | Full Time

$122k-155k (estimate)

4 Days Ago

Role Overview. Healthcare Value Optimization (HVO) is AmeriHealth Caritas’ enterprise-wide margin improvement program, which delivers value for the organization through improved member experience, health outcomes, and total cost of care. HVO collaborates closely with functional and market leaders, following a rigorous process to identify, validate, implement, and monitor improvement initiatives across unique workstreams. The Manager position ensu...

Bilingual Contract Specialist at AmeriHealth Caritas

Orlando, FL | Full Time

$63k-81k (estimate)

5 Days Ago

Community Educator at AmeriHealth Caritas

Halifax, NC | Full Time

$67k-88k (estimate)

7 Days Ago

Your career starts now. We are looking for the next generation of health care leaders. At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities. As one of the nations 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 seekin...

Behavioral Health Utilization Management Review at AmeriHealth Caritas

Baton Rouge, LA | Full Time

$85k-109k (estimate)

1 Week Ago

Role Overview. Under the direction of the Supervisor, the Behavioral Health Utilization Management (BHUM) Reviewer is responsible for completing medical necessity reviews. Using clinical knowledge and experience, the clinician reviews provider requests for inpatient and outpatient services, working closely with members and providers to collect all information necessary to perform a thorough medical necessity review. It is within the BH UM Reviewe...

Provider Network Operations Analyst Sr at AmeriHealth Caritas

Charleston, SC | Full Time

$84k-104k (estimate)

1 Week Ago

Responsibilities. The primary purpose of the job is to be responsible for the maintaining current provider data and provider reimbursement set up, and to address provider/state inquiries as it relates to claim payment issues. Develops the Pricing Agreement Templates (PAT) for all provider reimbursement set up. Ensure that provider payment issues submitted by Provider Network Management or any other source are validated, researched and resolved wi...

Senior Provider Communication Specialist at AmeriHealth Caritas

Manchester, NH | Full Time

$91k-110k (estimate)

1 Week Ago

Role Overview. The Senior Provider Communications Specialist is responsible for managing all communication initiatives that impact internal and external stakeholders from the provider perspective. This includes coordinating written and online communications for physicians, hospitals, and ancillary providers. Work Arrangement. Hybrid – The associate must be in the office at least three (3) days per week at our Manchester, New Hampshire (NH) locati...

Care Manager RN at AmeriHealth Caritas

Lugoff, SC | Full Time

$84k-101k (estimate)

1 Week Ago

Role Overview. The Care Manager II is responsible for managing and coordinating care, services, and social determinants of health for Members with acute, chronic, medically complex and/or behavioral health conditions and other health needs. Serves as the primary point of contact for the care team that includes Members, physicians as well as community supports to guide members in achieving their optimal level of health. Utilizes strong assessment ...

Maternity Case Manager at AmeriHealth Caritas

Detroit, MI | Full Time

$93k-112k (estimate)

1 Week Ago

Role Overview. The Care Manager assists members who are appropriate for care management and care coordination services in achieving their optimal level of health through self-management. The Care Manager is responsible for engaging with the member, the member's caregiver, and providers to assess the plan and establish individualized goals for each member. Will facilitate and coordinate care for members while ensuring the quality and use of cost-e...

Maternity Case Manager at AmeriHealth Caritas

Detroit, MI | Full Time

$93k-112k (estimate)

1 Week Ago

Market President, New Hampshire at AmeriHealth Caritas

Manchester, NH | Full Time

$168k-229k (estimate)

2 Weeks Ago

Your career starts now. We’re looking for 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 ...

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