AmeriHealth Caritas jobs in Philadelphia, PA - 44 jobs

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 Performance Management Senior Analyst will support this program in driving value realization across the business through the delivery of initiatives and capabilities. Work Arrangement * This is HYBRID position. Associate will work in our beautiful Ellis Preserve office located in Newtown Square, PA at least three (3) days per week, including core days of Tuesday, Wednesday, and Thursday Responsibilities * Supporting Performance Management Director and collaborating with business leaders and other stakeholders to develop a robust business case by performing root cause analysis, gathering data, and resolving any issues or concerns * Identifying risks to implementation and sustainability of project outcomes and partner with business leads to develop mitigation strategy * Leading the planning and execution of key projects related to overall Performance Management goals by identifying and reinforcing project objectives, strategic considerations, and milestones * Helping create executive-level updates on projects to senior executives, and facilitate business leaders doing the same by collaborating to develop clear, top-down communications (e.g., PowerPoint presentations, memos, quick status updates) * Performing and presenting relevant analysis, trends, past/future activity, and conclusions to facilitate decision-making and drive value realization * Organizing raw data, running report queries, and analyzing data outputs to clearly communicate results * Assist in training other Performance Management Business Analysts Education and Experience * Bachelor's Degree * At least four (4)+ years of work experience in a collaborative, problem solving, or analytical field * Experience in synthesizing complex analysis, meeting deadlines and effectively communicating to leadership * Skilled in Microsoft Office * Ability to work effectively with people at all levels in an organization * Ability to manage progress of a strategic goal and ensure accountability of its success; ability to anticipate risks and manage accordingly * Strong entrepreneurial spirit and willingness to take initiative Our Comprehensive Benefits Package Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more. 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 talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver 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 administrative services. Discover more about us at ***************************

The Manager will focus on departmental integrity, learning, and data management. They will also be the Community HealthChoices Long-Term Service and Support subject matter expert, ensure compliance with program and contractual requirements, assist with developing and managing policies and procedures, and ensure alignment with State and Federal Requirements. Work Arrangement * Remote Responsibilities * Conduct audits related to departmental compliance with LTSS policies * Assists in the day-to-day management of the department and participates as an internal SME as directed * Development of workflow and desk-level tools for departmental education, training, and ongoing in-services * Assist in coordinating provider, staff, and member outreach, education, and training * Develop and coordinate departmental communication pieces for both internal and external stakeholders * Prepares, coordinates, and verifies data and reports for the LTSS department * Assures that outbound and inbound data are QA'd and prepared for submission promptly * Maintains and presents key metrics to departmental leadership routinely as directed * Directly oversee the transitional services function within the department * As needed in new business situations, assume the role of phasing in the State's Home and community-based Service system, roles, and responsibilities Education/Experience Bachelor's Degree required 3 to 5 years of experience with HCBS Waivers, Habilitation, Institutional Services, and Health Homes 3 to 5 years of Leadership and Management experience required Skills & Abilities Knowledgeable in preparing educational materials, presentations, and overall adult learning methodologies. Knowledgeable in basic data analytics related to aggregating, distinguishing, and displaying data for reporting purposes. Your career starts now. We are looking for the next generation of healthcare leaders. At AmeriHealth Caritas, we are passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in healthcare 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. We want to connect with you if you're going to make a difference. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with over 30 years of experience. We deliver 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 administrative services. Discover more about us at ***************************

**Role Overview: ;** The Clinical Appeals Reviewer is responsible for processing appeals and ensuring all milestones are met in compliance with regulatory requirements. This role involves outreach to appellants or their representatives, obtaining and reviewing medical records, packaging pertinent information into a case for determination, interacting directly with providers to obtain additional clinical information, and with members or their advocates to understand the full intent of the appeal. **Responsibilities:** + Process appeals, ensuring compliance with all regulatory milestones + Review medical records to identify Hospital-Acquired Conditions (HAC), ensure proper documentation, billing code compliance, and prevent reimbursement errors; + Outreach to appellants or their representatives to obtain and review medical records + Package pertinent information into a case for determination + Interact with providers to obtain additional clinical information + Engage with members or their advocates to understand the full intent of the appeal + Provide clinical expertise and determine medical necessity for case classifications when necessary + Perform front-line regulatory/compliance functions in the evaluation of appeals + Review appeal cases and ensure the Medical Director makes timely decisions; + Review final determinations and create decision letters containing required information as regulatory entities dictate + Present cases to committees when necessary + Utilize InterQual criteria and apply them to appeals reviews + Stay current with the department and AmeriHealth Caritas policies and procedures + Familiarize yourself with and comply with federal, state, and local regulations, such as the National Committee Quality Assurance (NCQA) standards related to appeal and grievance operations **Education & Experience:** + Bachelor's degree (BSN) required + 3 or more years of experience in a related clinical setting and working with diagnosis procedure codes + Working knowledge of InterQual criteria + Proficiency in a Windows 10 environment and utilizing MS Office, including Word, Excel, and Outlook + Familiarity with the appeals process, preferably within a managed care organization **Licensure:** + Current and unrestricted Registered Nurse (RN) licensure or compact state licensure **Skills & Abilities:** + Strong verbal and written communication, critical thinking, presentation, and the ability to manage and complete multiple high-priority tasks within designated timeframes. ; Your career starts now. We're looking for the next generation of healthcare 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 healthcare 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 a difference, we'd like to hear from you. Headquartered in Newtown Square, PA, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver 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 administrative services. Discover more about us at *************************** **Our Comprehensive Benefits Package** Flexible work solutions include remote options, hybrid work schedules, competitive pay, paid time off, including holidays and volunteer events, health insurance coverage for you and your dependents on Day 1, 401(k), tuition reimbursement, and more. As a company, we support internal diversity through: Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.

Working under the direction of the VP - Chief Audit Executive and Head of Enterprise Risk Management (ERM), this position will assist in facilitating the continued development and execution of risk management, internal audit, internal controls, and governance processes throughout AmeriHealth Caritas, including Own Risk and Solvency Assessment (ORSA) reporting and the use of the Governance, Risk, and Compliance technology platform. Responsibilities: * Lead and develop staff and coordinating roles and activities across multiple integrated risk management responsibilities, including enterprise risk assessments, applied risk management and advisory projects, as well as internal controls and governance functions, provide a consolidated view and support model for business leadership, and align ERM processes with internal audit activities. * Facilitate the identification, assessment, and management of risks throughout AmeriHealth Caritas. Align the qualitative and quantitative aspects of the ERM program. * Develop methodologies for the assessment, analyzing, and managing risks, and establish monitoring and reporting metrics based on risk information. * Conduct risk assessments and analyses for key strategic, financial, growth, and operational projects across the organization. * Identify and analyze industry trends and influencing factors for risks and opportunities to enhance the company's risk management capabilities. * Conduct ad hoc analyses as directed by the VP - Chief Audit Executive and Head of ERM, the ERM Committee, or the Audit, Risk & Compliance Committee. As needed, provide results and reporting to the Executive Council. Work Arrangement: Remote, but must be available Monday-Friday between 8am-5pm Education * Bachelor's Degree preferred or related work experience required. * Master's Degree Preferred Experience: * Significant leadership experience required. * Ability to drive and manage change within and across the integrated Audit and ERM function and throughout AmeriHealth Caritas. * Strong facilitation, collaboration, and teamwork skills with the ability to build cross-functional partnerships and influence leadership at all levels. * Deep understanding of financial risk-management concepts. * Innovative and creative, with the ability to embrace change and think outside the box. * Strong problem-solving and critical thinking skills. * Strong organizational skills, with the ability to apply good judgment and resolve ambiguities. * Excellent oral and written communication skills, with strong interpersonal capabilities. * Self-motivated with demonstrated project management skills. * Strong analytical and research skills, with the ability to synthesize information and provide practical business solutions to achieve meaningful results. * Working knowledge of the healthcare industry. * Public accounting or related management consulting experience is a plus. * Risk management certifications-such as Certified Public Accountant (CPA), Certified Internal Auditor (CIA), Chartered Financial Analyst (CFA), Certified Management Accountant (CMA), or actuarial designation is a plus. Our Comprehensive Benefits Package Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more. 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 talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver 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 administrative services. Discover more about us at ***************************

The Manager will focus on departmental integrity, learning, and data management. They will also be the Community HealthChoices Long-Term Service and Support subject matter expert, ensure compliance with program and contractual requirements, assist with developing and managing policies and procedures, and ensure alignment with State and Federal Requirements. **Work Arrangement** + Remote **Responsibilities** + Conduct audits related to departmental compliance with LTSS policies + Assists in the day-to-day management of the department and participates as an internal SME as directed + Development of workflow and desk-level tools for departmental education, training, and ongoing in-services + Assist in coordinating provider, staff, and member outreach, education, and training + Develop and coordinate departmental communication pieces for both internal and external stakeholders + Prepares, coordinates, and verifies data and reports for the LTSS department + Assures that outbound and inbound data are QA'd and prepared for submission promptly + Maintains and presents key metrics to departmental leadership routinely as directed + Directly oversee the transitional services function within the department + As needed in new business situations, assume the role of phasing in the State's Home and community-based Service system, roles, and responsibilities **Education/Experience** Bachelor's Degree required 3 to 5 years of experience with HCBS Waivers, Habilitation, Institutional Services, and Health Homes 3 to 5 years of Leadership and Management experience required **Skills & Abilities** Knowledgeable in preparing educational materials, presentations, and overall adult learning methodologies. Knowledgeable in basic data analytics related to aggregating, distinguishing, and displaying data for reporting purposes. Your career starts now. We are looking for the next generation of healthcare leaders. At AmeriHealth Caritas, we are passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in healthcare 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. We want to connect with you if you're going to make a difference. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with over 30 years of experience. We deliver 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 administrative services. Discover more about us at *************************** As a company, we support internal diversity through: Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.

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 will contribute to the care coordination process by performing face-to-face assessments to identify, evaluate, coordinate, and manage participant's needs, including physical health, behavioral health, social services, and long-term services and support, as well as telephonic follow-up. Work Arrangement * Remote * Must be able to travel up to 90 minutes from your home to Chester, Bucks, Montgomery, Delaware, and Philadelphia Pennsylvania counties Responsibilities * Identify, coordinate, and assist participants in accessing needed LTSS services and other Covered Services, as well as non-covered medical, social, housing, educational, and other services and supports * Lead the participant-centered planning and service (PCPS) delivery process and oversee its implementation * Inform participants about available required needs assessments, the PCSP process, service alternatives, and service delivery options * Informs participants of their rights and assists with the complaint, grievance, and DHS Fair Hearing process * Collect additional necessary information, including participant preferences, strengths, and goals, to inform the development of the PCSP * Conducts reevaluation of level of care annually or more frequently as needed following CHC requirements * Works with the participant to complete activities necessary to maintain eligibility Education and Experience * Bachelor's Degree in social work, psychology, or related field is preferred * 3+ years of social service (in lieu of a Bachelor's degree) or related healthcare experience that required the following: * working with people who need personal care services, * conducting face to face visits in the home or nursing facility focused on needs assessments and monitoring delivery of services * knowledge of the home and community-based service system and how to access/arrange for services * maintaining contact and relationships with healthcare professionals on a regular cadence, providing consistent and timely feedback to members' needs and requests. * 2 to 3 years of Case management experience Licensure * Valid and current driver's license Skills & Abilities * Must be computer proficient and have a working knowledge of MS Office specifically Excel * High speed internet * Dedicated home workspace free from distractions and conducive to HIPAA and Government compliance regulations AmeriHealth Caritas is seeking service-oriented, compassionate healthcare professionals to join our Long Term Services and Support (LTSS) team. Ideal candidates will have experience assessing those needing personal care services for instrumental daily living activities AmeriHealth Caritas is a mission-driven organization with more than 40 years of experience delivering comprehensive, outcomes-driven care to those who need it most. We are 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. We'd like to hear from you if you want to make a difference in people's lives. Our Comprehensive Benefits Package Flexible work solutions, including remote options and hybrid work schedules, Competitive pay, Paid time off, including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement, and more.

Your career starts now. We are looking for the next generation of health care leaders. **This position is remote however, you must live and be able to travel within Ohio as business needs.** 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 seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we would like to hear you. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver 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 administrative services. Discover more about us at *************************** The Investigator is responsible for conducting 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. + Conducts investigations of potential; fraud, waste and/or abuse with a focus on thoroughness and attention to detail, quality, timeliness and cost control. + Conducts comprehensive interviews with providers, members and witnesses to obtain information which would be considered admissible under generally accepted criminal and civil rules of evidence. + Proactively performs research using the Internet, data analysis tools, etc., to analyze aberrant;claims billing and practice patterns. + Analyzes data as part of the investigative process using available fraud detection software and corporate resources. + Represents ACFC in conducting settlement negotiations with providers, counsel and/or other associated parties. + Prepares and submits investigative reports covering all phases of the investigation. + Interprets and conveys highly technical information to others.; + Establishes and maintains liaison with public officials, law enforcement and others to obtain assistance in conducting investigations. + Performs necessary functions to support all aspects of SIU investigations and responsibilities to include, but not limited to: Intake; Screening; Reviews; Referrals; Recoveries; and Provider Investigative Site Visits.;;; **Education/ Experience:** + Bachelor's degree with a minimum of two years of experience in the healthcare field working in fraud, waste, and abuse investigations and audits OR + An associate's degree, with a minimum of four years of experience working in healthcare fraud, waste, and abuse investigations and audits. + Experience and training/certifications commensurate with position requirements in lieu of formal educational requirements for the Lead SIU Investigator position may be considered.; + Valid driver's license required + Data Analytics experience preferred. + Ability to work independently with minimal supervision, and manage a high volume of assignments. + Strong verbal and written communication skills. + High degree of integrity and confidentiality required handling information that is considered personal and confidential.;; + Analytical skills and ability to make deductions; logical and sequential thinker. + A minimum of 3-5 years experience conducting comprehensive health care fraud ;investigations; interacting with state, federal and local law enforcement agencies. **Other Skills: ;** + Health care industry and/or Medicare/Medicaid/Pharmacy/Behavioral Health/Pharmacy Benefit Management knowledge required. + Clinical Experience preferred + SIU and/or State Medicaid regulatory compliance;work experience preferred. + Knowledge and; proficiency in claims adjudication standards & procedures preferred. + Solid knowledge of Medicaid, Medicare, and pharmacy benefit laws and requirements; federal, state, civil and criminal statutes. + Experience with decision support tools used for data analysis. + Advanced knowledge and experience working on various approaches to fraud, waste and abuse. + Working knowledge of Microsoft applications, especially Excel required. + Knowledge of available resources (internal and external) to assist in investigations. **Diversity, Equity, and Inclusion** At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve. We keep our associates happy so they can focus on keeping our members healthy. **Our Comprehensive Benefits Package** Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more. As a company, we support internal diversity through: Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.

Under the direction of a supervisor, the Utilization Management Reviewer evaluates 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 Utilization Management Reviewer assesses the appropriateness of services, identifies care coordination opportunities, and ensures compliance with medical policies. When necessary, cases are escalated to the Medical Director for further review. The reviewer independently applies medical and behavioral health guidelines to authorize services, ensuring they meet the patient's needs in the least restrictive and most effective manner. The ;Utilization Management Reviewer must maintain a strong working knowledge of federal, state, and organizational regulations and consistently apply them in decision-making. Productivity expectations include meeting established turnaround times, quality benchmarks, and efficiency metrics in a fast-paced environment. ;The Utilization Management Reviewer will also be counted upon to: **Work Arrangement** + Remote role + Availability to work Monday through Friday from 8:00 AM to 5:30 PM EST with flexibility for evenings, holidays, occasional overtime, and weekends based on business needs ; **Responsibilities** + Conduct utilization management reviews by assessing medical necessity, appropriateness of care, and adherence to clinical guidelines + Collaborate with healthcare providers to facilitate timely authorizations and optimize patient care + Analyze medical records and clinical data to ensure compliance with regulatory and payer guidelines + Communicate determinations effectively, providing clear, evidence-based rationales for approval or denial decisions + Identify and escalate complex cases requiring physician review or additional intervention + Ensure compliance with industry standards, including Medicare, Medicaid, and private payer requirements + Maintain productivity and efficiency by meeting established performance metrics, turnaround times, and quality standards in a high-volume environment **Education & Experience** + Associate's Degree in Nursing (ASN) required; Bachelor's Degree in Nursing (BSN) preferred + Minimum of three (3) years of clinical experience in Intensive Care Unit (ICU), Emergency Department (ED), Medical-Surgical (Med-Surg), Skilled Nursing Facility (SNF), Rehabilitation, or Long-Term Acute Care (LTAC) settings + Minimum of 2 years of Utilization Management experience, preferably in a managed care organization + Proficiency in Electronic Medical Record Systems and Utilization Review Systems (e.g., JIVA) to efficiently document and assess patient cases + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, and regulatory compliance + Demonstrated ability to meet productivity standards in a fast-paced, high-volume utilization review environment **Licensure** + An active and unencumbered Registered Nurse (RN) license under the Nursing Licensure Compact (NLC) + Ability to obtain additional licensure in MI and DC + Valid Driver's License ; Your career starts now. We are looking for the next generation of healthcare leaders. At AmeriHealth Caritas, we are 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. We want to connect with you if you want to make a difference. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with over 30 years of experience. We deliver 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 administrative services. Discover more about us at *************************** **Our Comprehensive Benefits Package** Flexible work solutions include remote options, hybrid work schedules, competitive pay, paid time off, including holidays and volunteer events, health insurance coverage for you and your dependents on Day 1, 401(k), tuition reimbursement, and more. ; As a company, we support internal diversity through: Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.

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 seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we would like to hear you. Headquartered in Newtown Square, Pennsylvania, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver 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 administrative services. Discover more about us at *************************** **Responsibilities:** The Utilization Management Tech functions under the direction of the Supervisor to coordinate, generate, and track both incoming and outgoing correspondence, faxes, and authorizations related to prospective, concurrent, and post-service review functions. Interacts with facilities, vendors, providers, and other staff to facilitate receipt of information and /or records for prompt review and response. ;Compensation plans for physicians, licensed nurse reviewers, staff, and consultants who conduct medical management do not contain incentives, directly or indirectly, that encourage barriers to care and service in making determinations. **Education/ Experience:** + High School/GED required. + Associate's Degree or equivalent education & experience preferred + Minimum of 1 year of general office and/or customer service experience preferred + Work experience in utilization management/review in a healthcare/MCO setting preferred + Knowledge of medical terminology preferred + Minimum of 1 year experience in Managed Care, Insurance, or Call Center preferred + Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint) required **Our Comprehensive Benefits** Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more. As a company, we support internal diversity through: Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.

The Medical Director, Utilization Management, provides organizational leadership in the operational areas of appeals, utilization review, quality improvement, and related policy and practice initiatives in collaboration with the Corporate Medical Director(s), Utilization Management, and the Vice President, Medical Affairs. The following responsibilities are regarding 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 non-network providers. + Engaging the provider network in Continuous Quality Improvement through the diffusion of practice standards and an internal quality assurance program that measures network provider performance against high-quality standards, especially the HEDIS program's performance standards. + Ensuring a high-performing Medical Management system that adheres to the terms of contracts and all relevant regulatory requirements. + Utilizing evidence-based standards in making coverage determinations. **Work Arrangement:** + Full Time Remote with required evening, weekend, and holiday coverage. **Accountabilities:** + Ensures quality and clinically sound services for all enrollees through associates and providers. + Serves as medical advisor and manager for all clinically related activities. + Ensures that the organization's medical policies and procedures adhere to contractual obligations. + Performs clinical case reviews in conjunction with the Medical Excellence Department. + Demonstrates knowledge of prescribed and established medical procedures and practices. + Maintains familiarity with federal, state, and local medical and clinical operations regulations. Provides leadership in developing and implementing medical policy related to health management, compliance with applicable regulatory guidelines, AmeriHealth Caritas clinical policies and procedures, and contractual obligations. + Manages day-to-day operations and monitors the integration and processing of members to optimize the appropriate use of behavioral and physical health services. + Participates with Quality Improvement and Medical Excellence in identifying and analyzing medical and behavioral health information to develop interventions to improve the clinical effectiveness of medical management strategies. Work closely with a multidisciplinary team to ensure behavioral health management and quality management programs meet contractual obligations. + Works with the leadership of the Quality Improvement and Medical Excellence departments to develop competent clinical staff. + Trains staff on medical issues and provides consultation to staff as appropriate. + Assists Care Managers in assessing members' needs for case management services and attends meetings and monthly rounds as scheduled. + Collaborates with the integrated case management team during scheduled meetings and informally as needed + Thoroughly documents all care coordination activity in the member's medical record in the electronic case management documentation system. **Education/Experience:** + MHA, MPH, or MBA in healthcare management preferred. + A minimum of three (3) years of utilization management or appeal experience in a Medicaid, Medicare, dual eligible, or commercial health plan is preferred. + A minimum of five (5 )years of clinical practice experience is required. + Experience working with Medicaid or Medicare preferred. + Proficiency utilizing MS Office (Word, Excel, Outlook), internet applications, and electronic medical record and documentation programs. **License Requirement:** + Doctor of Medicine (MD) or Doctor of Osteopathic Medicine licensed to practice as a medical director; additional state licensure required in all states where ACFC has a line of business, and that application is expected within 30 days of hire. + Current Pennsylvania license required, must be willing to obtain additional licenses where AmeriHealth Caritas has health plans. + Must be Board-certified in Family Medicine, Internal Medicine, Pediatrics, or Emergency Medicine. Must be clear of any sanctions by the applicable state or the Office of the Inspector General. + Must not be prohibited from participating in any Federally or state-funded healthcare programs. **Other Skills:** + Strong written and oral communication skills are required. **Our Comprehensive Benefits Package** Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more. 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 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 a difference, we would like to connect with you. Headquartered in Newtown Square, Pennsylvania, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver 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 administrative services. Discover more about us at *************************** As a company, we support internal diversity through: Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.

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 talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver 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 administrative services. Discover more about us at ************************** . **This position is hybrid in Philadelphia, PA** **Job Summary** The Appeals & Grievance Case Resolution Specialist is responsible for the full life cycle of assigned member and/or provider appeals and grievance cases. Working under general supervision, this role conducts case intake, investigation, and documentation to ensure accurate and timely resolution consistent with federal state, and accreditation standards. The Specialist serves as a key liaison between members, providers, and internal departments to resolve issues effectively, ensuring the integrity of the appeals and grievance process and compliance with CMS, NCQA, URAC, and state regulatory requirements. **Essential Functions** **_Case Management_** + Research and analyze case documentation, including benefit coverage, prior authorizations, claims, and regulatory guidance. + Communicate with members, providers, or representative to clarify appeal intent and gather missing documentation including incoming calls, outgoing calls, and phone queue work as assigned. + Prepare complete and compliant case files, ensuring all required documentation is included. + Track case progress and maintain compliance with turnaround times and documentation standards. + Generate accurate and timely determination and acknowledgement letters. **_Investigation and Resolution_** + Collaborate with internal departments such as Claims, Medical Management, Legal, and Compliance to obtain necessary information for resolution. + Identify potential compliance issues or risk factors requiring escalation. + Participate in case discussions, internal committee reviews, or external fair hearing preparation as assigned. + Document all activities, correspondence, and outcomes in the case management system with attention to detail and accuracy. **_Compliance & Quality_** + Ensure case handling meets all application federal and state regulatory requirements, including with CMS, NCQA, and URAC. + Maintain confidentiality and protect member information in compliance with HIPPA regulations. + Identify opportunities for process improvements to enhance quality and efficiency. **_Team Collaboration_** + Serve as a resource to peers and administrators for routine case-related questions.; + Maintain professional communication with members, providers, and internal stakeholders.; + Participate in team meetings and contribute to continuous improvement initiatives. **Education/Experience** + Associate's Degree: in Health Administration, Business, or related field required Preferred Experience Level: + Knowledge of medical terminology, benefit interpretation, and regulatory processes preferred. Prior experience working with CMS, Medicaid, or state-regulated appeals processes preferred. + 2 to 3 years experience in healthcare operations, managed care, or grievance/appeals coordination. **Other Skills** + Proficiency in Microsoft Office Suite (Word, Excel, Outlook, etc.). + Strong attention to detail and organization. + Excellent written and verbal communication. + Ability to manage multiple priorities in a fast-paced environment. + Strong analytical and problem-solving abilities. + Customer service orientation with professional communication etiquette. **Our Comprehensive Benefits Package** Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more. As a company, we support internal diversity through: Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.

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 talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver 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 administrative services. Discover more about us at ************************** . **Responsibilities:** Audit and analyze all Facets configuration changes completed by the configuration analysts to ensure that all modifications have been completed correctly. Review all associated documentation for completeness. Communicate with the configuration analyst, configuration team lead, tester, and requestor as required to ensure the request is completed as intended. Document all issues identified in the audit process and communicate the audit outcome to the appropriate persons. The auditor will validate production to ensure that the case is migrated appropriately. After changes migrate into production, a full post-implementation review is completed as the policy outlines. The auditor will be expected to build/run complex queries to identify claims affected by the configuration change and analyze all claims to ensure that all outcomes are accurate based on the request. Auditors must possess a comprehensive knowledge of technical and workflow process components of claims processing.;All auditors must attend ongoing training as needed and meet all production and quality goals to assist the team in meeting all required Service Level Agreements. **Education/Experience:** + High School Diploma/GED required + Bachelor's Degree preferred + Minimum of 1 year of advanced-level claims experience and auditing experience + Minimum of 3 years of system configuration experience + Facets claim processing knowledge required + Microsoft Access or equivalent relational database application experience + Ability to build complex queries, reports, and macros **Diversity, Equity, and Inclusion** At Amerihealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve. We keep our associates happy so they can focus on keeping our members healthy. **Our Comprehensive Benefits Package** Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more. As a company, we support internal diversity through: Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.

**Role Overview:** The Contract Specialist connects our team, the health plan, and key stakeholders. This role focuses on building and maintaining collaborative relationships while ensuring contract data and documents are accurately reflected across systems. Responsibilities include hands-on contract administration, issue resolution during contract loading, and maintaining compliance standards. **Work Arrangement** : Remote; Anywhere within the continental U.S. **Responsibilities** + Build and maintain positive relationships with internal teams, health plans, and stakeholders. + Ensure contract data and documents are accurately represented in operating systems. + Act as a proactive contract administrator, resolving contract-related issues. + Audit contract documents and provider records for accuracy. + Manage and monitor Excel reports for projects and assignments. + Create and align contract records in the contract management system with 95% accuracy. + Monitor electronic contract files and ensure compliance with policies. + Escalate requests that conflict with business processes or contract language. + Support departments in investigating provider data and credentialing. + Research and resolve discrepancies in data and documentation. + Identify and report compliance issues. + Maintain knowledge of Facets or other claims systems and communicate contract corrections. + Communicate effectively and professionally with all parties. + Collaborate with departments to execute AmeriHealth and health plan strategies. + Perform administrative duties and attend required training sessions. + Stay current on AmeriHealth and health plan regulations, policies, and procedures. **Education & Experience** + High School diploma or GED required; Bachelor's degree preferred. + 1-2 years of experience in provider network management, finance operations, contract management, or contract administration within healthcare or managed care. + Experience with contracting software (e.g., Portico, McKesson, Conga, Salesforce). + 1-2 years of managed care experience required. **Our Comprehensive Benefits Package** Flexible work solutions including hybrid work schedules, competitive pay, paid time off including holidays and volunteer events, health insurance coverage for you and your dependents, 401(k), tuition reimbursement, and more. At AmeriHealth Caritas, we are 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 on 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 a difference, we would like to hear from you. Headquarters in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver 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 administrative services. As a company, we support internal diversity through: Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.

**PerformRx** is a Pharmacy Benefits Manager (PBM) dedicated to clinical culture, boutique service, and holistic solutions. Our mission is to help clients, providers, and members use effective medication therapy to improve health and wellness. For over two decades, our focus has been on providing optimal service through a clinical culture that seeks to provide members with high-quality care while ensuring our partners receive favorable costs. That culture is reflected in our employees - more than 80 percent of our staff members are Pharmacists and Pharmacy Technicians - and in the services we provide. **PerformRx** ;is headquartered in Philadelphia. Our dedication to innovation and to providing the most efficacious outcomes is the core of our clinical culture and is the heart of PerformRx. PerformRx is a subsidiary of the AmeriHealth Caritas Family of Companies. **Role Overview** The Pharmacy Technician I supports the organization's mission and purpose by providing front-line customer support for a diverse portfolio of customers. The incumbent will;handle inbound telephone inquiries from Members, pharmacies, and Prescribers in our National Customer Care Center, and will consistently meet established productivity, schedule adherence, and quality standards. **Work Arrangement** + Remote Must be able to work one of these shifts plus rotating holidays. + 12:30pm - 9:00pm Monday - Friday; + 12:30pm - 9:00pm Sunday - Thursday; + 10:30am - 9:00pm Wednesday-Saturday; **Responsibilities** + Provide real-time support to pharmacies with point-of-service inquiries + Educate prescribers on formulary and prior authorization processes + Enter customer data and other relevant information into our documentation tool + Assist members with pharmacy benefit inquiries; + Adhere to standard operating procedures to ensure contact handling accuracy and operational effectiveness + Effectively communicate issues and resolutions to customers and appropriate internal staff **Education and Experience** + Bachelor's degree or equivalent experience;required + Minimum; **three (3) years** ;of current/recent PBM and/or current/recent pharmacy experience;required **Licensure** + Active/current National Pharmacy Technician Certification (NHA or PTCB) or ability to obtain one within the first six (6) months of employment is;required Your career starts now. We are looking for the next generation of healthcare leaders. At AmeriHealth Caritas, we are passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in healthcare 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 a difference, we would like to connect with you. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver 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 administrative services. Discover more about us at ************************** **Our Comprehensive Benefits Package** Flexible work solutions include remote options, competitive pay, Paid Time Off (PTO), including holidays and volunteer events, health insurance coverage for you and your dependents on Day 1, 401(k), tuition reimbursement, and more. As a company, we support internal diversity through: Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.

The Director, Facilities Management is responsible for overseeing the operations, maintenance, and strategic planning of all physical buildings, grounds and infrastructure within the organization. This role ensures that facilities are safe, functional compliant and aligned with the organization's goals. The Facilities Director manages a team of maintenance personnel and coordinates with external contractors and vendors. Work Arrangement * This is an office based position located at our Newtown Square / Ellis Preserve office Responsibilities * Oversee all Facilities activities across the enterprise. Manage vendors and staff related to maintenance, repair and improvement of all facilities across the footprint. Develop and implement facilities policies and procedures. * Vendor management-manage relationships with service providers i.e. janitorial, food service, fitness centers. Implement energy saving initiatives and sustainable practices * Compliance, Safety & Sustainability: Ensure facilities meet all local, state and federal regulations (OSHA, Fire and Building Codes) * Establish and develop a high performing team that supports facilities for the enterprise. Provide leadership to drive performance that is aligned with the company's mission, values and priorities. Drive associate engagement activities that ensure that associates are appreciated, valued and connected to the mission of the department and larger organization. Manages staff and services in a coordinating leadership role for all facilities staff throughout the company * Provide management and oversight for facilities capital planning, projects, improvements and strategic maintenance activities. Provide strategic facilities planning - assessing current and future needs. Develop and manage capital budgets. Plan and manage an annual combined budget * Lead master planning efforts. Responsible for managing the activities of the department's staff and contracted resources to provide all required project management services to engaged stakeholders, procure services, design in accordance with codes, and complete construction within established financial, functional, operational, and scheduling goals * Work collaboratively with other cross functional teams (PMO, IS, Finance, affiliates, etc.) to deliver on project commitments. Work with internal technology teams to address technology needs for the all new space, and integrates these effectively into planning, renovation and building efforts. Education and Experience: * At least five (5) or more years related experience in a Facilities Leadership role * Proven ability in strategic planning, decision-making, and problem-solving * Well developed skills in vendor management, construction contracting, and Building Management Systems (BMS) * Strong collaboration skills with the ability to motivate staff and drive adoption and contribution from all parts of the organization * Develop preventative maintenance program for buildings, mechanical, electrical, utility and safety * Maintain compliance with government, accreditation, and regulatory standards * Certification as Certified Facility Manager (CFM) or Facilities Management Professional (FMP) * Bachelor's Degree in Facilities Management, Business Admin, Engineering, or related * Must have experience managing commercial office space (300K square feet or larger) * Valid Driver's License in state of residency Our Comprehensive Benefits Package Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more. 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 talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver 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 administrative services. Discover more about us at ***************************

Responsibilities: Under the general supervisor of the Manager Accounts Receivable, the analyst is responsible for identifying, validating, submitting and reconciling all maternity submissions accurately and timely for all applicable lines of business. Based on State specific methodology and timeframes- i.e. weekly, monthly; accurately submit maternity delivery data via Newborn/Maternity Tracking Tool for creation of 837P: * Accurately submit maternity delivery data via state web portals for individual maternity submissions; while also updating Newborn/Maternity Tracking Tool keeping systems in unison. * Ability to retain multiple sets of maternity criteria, medical billing logic and maternity mapping logic. * Responsible for Newborn//Maternity Tracking Tool system updates of ICD-10, Diagnosis codes, CPT, DRG, and procedure codes; Modifiers, Part A codes and Revenue rate data. * Be fluent with existing and new 820, 835 and 837P companion guides, system notices and or maternity documentation, adherence to requirements; advise management on needed actions to comply with state requirements as they occur. * Prepare EDI 820 premium payment files, EDI 835 maternity payment files and Adhoc files for data mapping documents at a column level from source columns mapped to appropriate target columns. * Continuous enhancement recommendations of Newborn/ Maternity Tracking tool for all plans. * Actively participates in Q/A of Newborn/Maternity tracking tool user acceptance testing functions, such as test script development, testing and documentation of test results. * Develops and maintains a complete understanding of all data sources (including, but not limited to the Data Warehouse, the Facets System and the NBTT) available for reporting so that research and analysis can be completed on discrepancies. * Responsible for meeting all monthly/ quarterly deadlines and provides full support to other areas such as Accounting, EDI, Enrollment, Encounters, Healthcare Apps, Statutory and the Actuarial departments. * Generates and updates reports for monthly maternity reconciliation, aging reports, financial audits and all other required reporting; Analyzes completed reports to ensure there are no material differences that should be escalated to management for review. * Maintains and creates maternity databases, queries, joins, tables and forms; designs and creates SQL stored procedures, technical specifications and user-defined functions, writing functional and technical specification documents. * Participates in the completion of all designated annual goals for the Financial Services department. * Communicates with management/stakeholders to determine appropriate courses of action prior to enacting changes in reporting processes. * Prepare for onsite audits of all tasks requiring process explanation and accountability. Education/Experience: * Bachelors' degree required. * 1 to 3 years knowledge of medical billing ICD-10, CPT DRG claims coding Revenue Code Mapping, Data Analysis, Data warehousing, translated 5010 EDI files, financial reporting and related financial analysis experience. * Basic understanding of Claims Processing / Clinical Coding and business practices. * Basic working knowledge of business computer programs, applications and systems, database structures and data files required. * 2 years experience in healthcare finance and/or financial reporting, preferred. * Strong communication (both written and verbal), analytical and problem solving skills. * Excellent organizational skills. * Ability to work on multiple tasks with competing priorities; demonstrates strong subject matter expertise in the states and business processes that they support. * Ability to work accurately and independently as well as comfortable interacting collaboratively with all levels of business; open mind to consider alternative ideas and next steps for remediation. Other Skills: * Efficient in Microsoft SQL Server, Oracle, My SQL, SQL Server Reporting Services. * Proficiency in Excel, Access, preferred. Our Comprehensive Benefits Package Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more. 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 a difference, we'd like to hear from you. Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver 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 administrative services. Discover more about us at ***************************

The Manager Provider Network Reporting manages a team of Data Analysts responsible for meeting provider network reporting needs related to the evaluation of network strength/adequacy and the identification of network gaps, in support of new business, new products, and RFPs **Work Arrangement** + Remote **Responsibilities** + Generates reports used to analyze network adequacy, perform gap analysis and support design & construction of optimally-sized networks meeting all state and federal regulatory requirements + Supports reporting for network intelligence and network management to achieve milestones and goals throughout new business lifecycle + Manages the development and implementation of business analysis and reporting needs to assure accuracy, compliance and delivery for RFPs, new and emerging markets, existing LOBs and new product + Manages the new business continuum for provider network reports and deliverables to monitor network development, gaps and strategy + Implements processes and programs for network analysis and reporting to optimize proficiency, efficiency and scalability + Work closely with business, plans, and network management to translate analytics into business impacts and network optimization **Education and Experience** + Five to ten (5 to 10) years of supervisory experience + Minimum of three (3) years of health care experience + Experience in Provider Network Management preferred + Previous experience in data analysis and reporting using SAS / SQL, Python, Excel, and Access preferred + Bachelor's degree **Skills & Abilities** + Competency in math, statistics, software programming and data management 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 talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver 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 administrative services. Discover more about us at ************************** . **Our Comprehensive Benefits Package** Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more. As a company, we support internal diversity through: Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.

Under the direction of the Vice President and Controller, the Corporate Tax Director is responsible for the Company's accounting for income taxes and compliance with tax regulations. This position is the lead functional and technical expert in all tax matters and collaborates with and governs the work outsourced to our tax specialists. Work Arrangement: * Hybrid - Associate must be in the office at least three (3) days per week, including core days of Tuesdays and Wednesdays, at our Newtown Square, PA headquarters Responsibilities: * Works in collaboration with our tax specialist to minimize tax liabilities of the Company through sound and informed application of tax laws and regulations. * Performs tax research to identify and implement appropriate guidance for complex transactions and oversees appropriate documentation of the Company's position. * Proactively stays apprised of all business or operational changes that could affect tax and assesses and communicates impacts accordingly. * Oversee the work of our tax specialists with respect to the preparation of the periodic GAAP and Statutory tax provisions as well as the federal, state, and local tax returns, including ensuring timely filing of returns and remittance of associated tax payments. * Responsible for the overall monthly/quarterly/annual close processes associated with the Tax function, including accuracy of the related tax general ledger accounts. * Maintains an understanding of GAAP, STAT, and Taxation currently applicable to the Companies and responsible for appropriate application of these principles and practices. * Ensures appropriate controls and policies are in place over accounting for income taxes and is responsible with assisting in the performance, documentation, and accuracy of all narratives and controls. * Advises on the preparation of the annual budget, periodic reforecasts, and strategic plan as it relates to taxes. * Responsible for communication with tax regulators as applicable. * Responsible for the professional development of departmental management and staff. * Responsible for execution and oversight of special projects and other appropriate duties as directed. Education/ Experience: * Bachelor's Degree (In Accounting or Finance). * CPA license required. * A thorough knowledge of all Federal, State and Local tax law and regulations is required. * Experience in the tax function of a large corporation or national public accounting firm is preferred. * Must have excellent oral and written communication skills, the initiative to self-start, the willingness and ability to work at a high level of productivity, strong managerial and analytical abilities, and the ability to relate well to co-workers and others. * Strong understanding of U.S. Generally Accepted Accounting Principles and the application thereof required. * Strong understanding of the NAIC's Statements of Statutory Accounting Principles and the application thereof preferred. * Minimum five (5) years experience in Tax accounting, tax return preparation, people management. Our Comprehensive Benefits Package Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more. 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 talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you. Headquartered in Newtown Square, PA, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver 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 administrative services. Discover more about us at *************************** #CO

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 talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver 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 administrative services. Discover more about us at *************************** The Provider Network Data Oversight Analyst performs the role of payment terms data source expert to support AmeriHealth Caritas nationwide across all products. They are responsible for oversight and validation of information from multiple external and internal sources and departments, assuring accuracy and validity while crystallizing results in recommendations. They independently manage multiple projects including the development of the business logic for the subsequent creation of standard queries and reporting. Under the direction of the Vice President - Network Pricing, provides analytical support to the Provider Network Management team by performing analysis of provider data, payment term changes, and general configuration. Responsibilities: * Collaborates with Actuarial, Network, and Operational areas to develop lenses that provide event triggered output for monitoring of impending contract changes and provider patterns. * Effectively prioritizes and communicates insights and recommendations. * Facilitates partnerships with Vendors, IT, Payment Systems, Operations Services, Provider Network Management, Market, and Clinical teams as needed to research financial issues, risks, and opportunities related to fee schedules, chargemasters, contract terms, and outliers. * Manages issue-tracking database to ensure that challenges are resolved within established timeframes and escalates open issues as needed. * Defines, develops, and/or implements data modeling tools or reports designed to routinely assess and support existing and new provider network management processes, programs, contract performance, and proposed initiatives, such as fee schedule development, provider contract interpretation' and system interfaces/integration. Education / Experience: * Bachelor's Degree required. * At least four (4) years of Analytics experience. * Advanced Microsoft Excel experience required. * Experience with SQL and BI Tools such as Power BI or Tableau required. * Superior analytical skills including the use of very large data sets; ability to recognize anomalies in findings, and pursue and/or recommend resolution. * Ability to work with integrated data from multiple sources. * Other relevant experience includes work with Databricks, SAS, Python, and R. * Demonstrated ability in effectively interfacing with key leaders and stakeholders both internal and external to the organization to research technical and/or operational issues and define solutions. * Must have excellent communication skills. We keep our associates happy so they can focus on keeping our members healthy. Our Comprehensive Benefits Package Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.