Bagley Township, Michigan, United States · Remote OK
Role Overview: The Community Health Educator, Senior supports the development and execution of outreach strategies within an assigned territory to improve health outcomes, reduce healthcare costs, and increase member eng…
Skills: Public Health Education, Community Outreach, Population Health, Member Engagement, SDOH Surveying
Southfield, Michigan, United States · Remote OK
Role Overview: The Director, ICT Care Coordination, is responsible for leading the strategic direction, operational execution, and performance of care coordination and population health programs within the assigned marke…
Skills: Population Health Strategy, Care Coordination, Case Management, Medicaid Managed Care, NCQA Standards
Columbus, Ohio, United States · Remote OK
Role Overview: The BrightStart Care Manager partners with members, caregivers, providers, and community resources to assess needs, develop individualized care plans, address barriers to care, and promote self-management …
Skills: Care Management, Case Management, Population Health, Clinical Assessment, Care Planning
Manchester, New Hampshire, United States · Remote OK
Role Overview: The Senior Clinical Quality Performance Specialist is responsible for overseeing, designing, and implementing quality initiatives, identifying root causes, establishing and executing work plans to implemen…
Skills: Data Analysis, Quality Improvement, HEDIS, CAHPS, NCQA Accreditation
District of Columbia, United States · Hybrid
$93k–$126k/yr
Work Arrangement: This position is a 4 days / week hybrid position in our DC office located at 1201 Maine SW. As a Provider Network Management Contractor, you will be responsible for the contracting and re-contracting of…
Skills: Contract Negotiation, Reimbursement Methodologies, Risk Based Contracting, Value Based Contracting, Financial Acumen
Summerville, South Carolina, United States · Hybrid
Work Arrangement: This position is a field based position based in the Charleston, Berkeley and Charleston counties. BSN RN or LICSW required. Role Overview: Responsible for managing and coordinating care, services, and …
Skills: Care Coordination, Behavioral Health Assessment, Case Management, Clinical Knowledge, Crisis Intervention
District of Columbia, United States · Hybrid
$83k–$113k/yr
Work Arrangement: This position is a hybrid position located in our DC office at 1201 Maine SW. This will be 4 days / week in the office and one day remote. Job Summary The primary responsibility of Account Executive Sr.…
Skills: Relationship Management, Value-Based Care, Network Development, Network Management, Provider Education
United States · Remote Solely
Job Summary Reporting to the Senior Medical Director of UM, the Per Diem UM Medical Director will be responsible for: Performing daily medical reviews, appeals, participating in appeal panel as appropriate, correspondenc…
Skills: Medical Review, Utilization Management, Evidence-Based Practice, Clinical Case Review, Conflict Resolution
United States · Remote OK
For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Th…
Skills: Enterprise Forecast Modeling, Financial Modeling, Assumption Governance, Variance Analysis, Scenario Analysis
Richland County, South Carolina, United States · Remote OK
Work Arrangement: This position is a remote field based position in the Richland county area. Must have a BSN RN. Will work with the Foster Care program. Responsible for managing and coordinating care, services, and soci…
Skills: Care Coordination, Clinical Assessment, Case Management, Patient Education, Medication Review
United States · Remote OK
For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Th…
Skills: Utilization Management, Clinical Case Review, Medical Policy Development, Peer-to-Peer Discussion, Regulatory Compliance
United States · Hybrid
Job Summary: This position reports to the Manager, Provider Reimbursement and is responsible for facilitating and investigating cross-departmental issue resolution as it relates to provider claim reimbursement. The prima…
Skills: Claims Analysis, Provider Reimbursement, Healthcare Billing, Medical Coding, Data Reconciliation
Detroit, Michigan, United States · Hybrid
Qualified candidates must live in or around Wayne and Macomb Counties in Michigan. For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsi…
Skills: Case Management, Staff Supervision, Process Improvement, Medicare LTSS, Clinical Direction
Tinicum Township, Pennsylvania, United States · Remote OK
Role Overview As a Service Coordinator, you will assist participants who qualify for Medicaid in obtaining the long-term services and support they need as required by the Community Health Choices (CHC) agreement. You wil…
Skills: Case Management, Needs Assessment, Care Coordination, Participant-Centered Planning, MS Office
United States · Remote OK
Your career starts now. We’re looking for the next generation of health care leaders. Role Overview Reporting to the Director, Proposal Strategy and Management, the Medicaid Proposal Management Director provides strategi…
Skills: Proposal Management, Capture Strategy, Medicaid Managed Care, Shipley Methodology, Risk Management
North Charleston, South Carolina, United States · Hybrid
Role Overview: Care Manager II (Field-Based, Remote) Responsible for managing and coordinating care, services, and social determinants of health for Members with acute, chronic, medically complex, and behavioral health c…
Skills: Care Coordination, Clinical Assessment, Case Management, Patient Education, Crisis Intervention
United States · Remote Solely
Role Overview: The Manager, Medical Economics & Business Process leads a team responsible for delivering healthcare data and medical economics analyses across a variety of data sources, including claims, authorizations, …
Skills: Medical Economics, Healthcare Data Analysis, SQL, Tableau, PowerBI
Florence, South Carolina, United States · Hybrid
Role Overview: Care Manager II (Field-Based, Remote) Responsible for managing and coordinating care, services, and social determinants of health for Members with acute, chronic, medically complex, and behavioral health c…
Skills: Care Coordination, Clinical Assessment, Case Management, Patient Education, Medication Counseling
Edgmont Township, Pennsylvania, United States · Remote OK
For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Th…
Skills: Strategic Planning, Business Planning, Analytics, Competitive Analysis, Market Research
United States · Hybrid
Role Overview Our Utilization Management Reviewers evaluate medical necessity for inpatient and outpatient services, ensuring treatment aligns with clinical guidelines, regulatory requirements, and patient needs. This ro…
Skills: Utilization Management, Medical Necessity Review, InterQual Criteria, Electronic Medical Record Systems, Care Coordination
Bagley Township, Michigan, United States • Remote OK
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Develop and execute outreach strategies to improve health outcomes and member engagement within assigned Michigan territories. Deliver health education, manage community-based programming, and mentor junior Community Health Educators.
Requires a Bachelor's degree and 3 to 5 years of experience in health education, public health, or community outreach. A valid driver's license and access to an insured vehicle are mandatory for extensive travel.
Role Overview: The Community Health Educator, Senior supports the development and execution of outreach strategies within an assigned territory to improve health outcomes, reduce healthcare costs, and increase member engagement. This role delivers health education, supports community-based programming, assists with Social Determinants of Health (SDOH) surveys, and documents outreach activities and outcomes in Jiva. The position operates in both field-based and wellness center settings (brick-and-mortar and mobile) and serves as a senior-level resource for community education initiatives.
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Our mission at AmeriHealth Caritas New Hampshire is to help people: Get care. Stay well. Build healthy communities.
At AmeriHealth Caritas New Hampshire, we're passionate about helping people get care, stay well, and build healthy communities. We are located in Manchester, NH and serve Medicaid recipients throughout the entire state of New Hampshire. AmeriHealth Caritas New Hampshire is part of the AmeriHealth Caritas Family of Companies. 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.
Offices: 25 Sundial Ave, 1st Floor, Manchester, New Hampshire 03103, US
Our mission at AmeriHealth Caritas New Hampshire is to help people: Get care. Stay well. Build healthy communities.
At AmeriHealth Caritas New Hampshire, we're passionate about helping people get care, stay well, and build healthy communities. We are located in Manchester, NH and serve Medicaid recipients throughout the entire state of New Hampshire. AmeriHealth Caritas New Hampshire is part of the AmeriHealth Caritas Family of Companies. 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.
Offices: 25 Sundial Ave, 1st Floor, Manchester, New Hampshire 03103, US