At AmeriHealth Caritas, care is the heart of our work. That means that every day we put our members and their families first. We work to improve not only their health, but also the economic and social issues that can act as a barrier to proper care ' the social determinants of health that are estimated to account for 70 percent of avoidable mortality in the U.S. alone. Through our Next Generation Model of Care, we emphasize preventive care, health maintenance, and community outreach programs with a strong focus on ensuring members have access to food, housing, utilities, and other basic necess ... ities. Our mission To help people get care, stay well, and build healthy communities. We have special concern for those who are poor. Our vision Our goal is to develop strategic partnerships and build accessible, flexible health systems across the nation. Moving forward as health care evolves, we will continue to ensure the greatest level of care at maximum value for members, providers, and governments. Ensuring equal access to health care through health equity and health literacy More than 77 million adults have basic or below basic health literacy ' or the ability to understand the basic health services and instructions they receive. Even more can't access the care they need because of social and cultural disparities. Low health literacy costs the U.S. billions of dollars every year and impacts the quality of care millions of Americans receive. In the spirit of our mission, our whole-person model of care leverages Culturally and Linguistically Appropriate Services (CLAS) standards and strong community partnerships. Through community outreach, collaboration with providers and their staff, and 24/7 access to interpretation services, we help to ensure each of our members gets the appropriate, unique care and services they need and deserve. More

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Responsibiities:. The Diversity, Equity & Inclusion Data Analyst position will support the planning, coordination, and management of various analytical and research projects as they relate to Amerihealth Caritas’ diversity, equity, and inclusion strategy and initiatives across our governance, workforce, procurement, programming , and community investment focus areas, and partner with analysts in other areas where the Company is driving Divesity, Equity & Inclusion (DE&I) initiatives.. Perform technical and analytical work for the company’s Diversity, Equity & Inclusion (DE&I) programs involvin... view job details

Responsibilities:. Under the oversight and direction of Accounting management and the Senior Accountants, the Accountant is responsible for maintaining the general ledger and preparing supporting schedules/reconciliations.  Responsibilities including, but not limited to:. Preparing all assigned journal entries in accordance with current financial standards and as required to accurately present financial activity in the general ledger. Preparing, reviewing, and analyzing all relevant, assigned, schedules (financial analysis package) supporting the financial statements. Reconciling all assigned ... view job details

Responsibilities:. Reporting to the Director, Enterprise Accreditation Programs and the Director, Quality Management, the Accreditation Specialist will serve as a business analyst to ensure system and process compliance with NCQA accreditation standards for all health plans.  This position will also assist with preparation of documents and survey process to enable successful accreditation reviews.  The position will monitor and establish a catalogue process for medical management policies for the assigned line of business. Interfaces with all departments to ensure process compliance and execut... view job details

Responsibilities:. Develop health care cost trend analytics as part of a dynamic team.  Build, deploy and maintain dashboards and analyses that support identification of meaningful medical and pharmacy cost trends.  Collaborate with subject matter experts to identify root causes of trends.  Work with markets and corporate functions to identify potential medical cost containment initiatives to manage MLR and develop tracking tools to identify realized vs expected savings targets.  Develop provider contracting tools and methodologies to support network teams – familiarity with value based contra... view job details

This position is responsible for performing administrative tasks such as. calendar scheduling,. entering data, compiling reports, assembling binders, building spreadsheets, distributing correspondence, recording and dispensing meeting minutes,. travel arrangements, expenses,. and making copies. In addition, this individual is tasked with creating presentations, updating manuals and coordinating mass mailings.   We are seeking someone with heavy Outlook calendar scheduling experience and strong Excel and PowerPoint skills. Education Experience:. High School/GED. Associate’s Degree - preferred. ... view job details

Reporting through the Associate Services Manager in Health Services (HS), the Administrative Assistant II will provide specialized and complex administrative activities in support of the Health Services Director(s), as well as ongoing support of all functional areas led by the Health Services Associate Services Director.  Responsibilities include providing critical support through research, analysis, and writing, information coordination, distributing correspondence, scribing, distributing meeting minutes, relationship management and assisting the HS Associate Services Manager as needed with m... view job details

Responsibilities:. Coordinates information and data exchange between Medical Management and Community Outreach Solutions Specialists/management team, evaluating resolution priority, urgency of issue, and appropriate stakeholders for resolution.   Tracks and inputs data from ongoing member programs, using thorough understanding of each program’s goals, process, timeframes and status to determine accuracy and validity of data.  Independently resolves accuracy/validity issues with appropriate stakeholders and management team.   Provides support at Marketing events, in addition to or in place of e... view job details

Responsibilities:. Under the general supervision of the Supervisor Appeals & Grievances, the Appeals Administrator assists Intake Coordinator, Coordinator Appeals and Grievances with administrative tasks, including, but not limited to, fax management (storage and distribution), letter processing and storage, data collection and assembling/filing completed appeals folders. Work in-office daily to process all appeals mail. Follow-up with members and providers regarding consent and educating on process. Receives and saves, on a department-wide basis, incoming faxes from the electronic fax system ... view job details

Responsibilities. :. The primary purpose of the job is to: Under the general supervision of the Director of Appeals and Grievances, this position screens calls from members and providers regarding the Part C, Part D and Medicare-Medicaid Plan appeals and grievances processes. In addition, the Coordinator will be responsible for retrieving grievances and appeals from the Customer Service database.  This position will be located in our Philadelphia main campus office and will support the appeals and grievances needs of our Medicare Advantage D-SNP and MMP membership. The Appeals and Grievances C... view job details

Responsibilities:. Under the direction of the Manager of Appeals, the Appeal Transcriptionist is responsible and accountable for transcribing all Appeals meeting accurately and within 5 business days of meeting. The Transcriptionist is responsible for maintaining PHI, ensuring that all records are accurate and uploaded to the member’s record. Also provides general administrative support of the team as needed. Listen to the recorded dictation of a doctor or other healthcare professional. Transcribe and interpret the dictation of the Appeals panel meeting and upload to the Member record. Review ... view job details