Job Brief
Bachelor's degree in healthcare related field req'd. Master's preferred. RN or LCSW or BH equivalent advanced licensure. 5+ years of exp in case and utilization management Medicare program design and implementation.
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 www.amerihealthcaritas.com.
Responsibilities:
In conjunction with the Vice President of Medicare Care Management and the Chief Medical Officer, the Corporate Director, Population Health Medicare Clinical Operations is responsible for multiple line of business clinical operations supporting Population Health objectives including Care Management, HRAs, Quality metrics, and the implementation and ongoing improvement of Model of Care performance, contractual obligations, compliance with State and Federal regulations, and NCQA requirements.
Responsible for the implementation and ongoing improvement of DSNP Model of Care creation and performance. Assures compliance of program execution with enterprise policies.
Monitors performance metrics across multiple LOBs and assures that appropriate action is taken to address performance opportunities consistent with enterprise policies.
Responsible for ongoing education and training for care management procedures in conjunction with the managers of each department.
Maintains consistent program implementation and staffing across all responsible LOBs consistent with enterprise policy.
Responsible for updating program descriptions, program evaluations, policies and procedures as required for Quality Assurance. Responsible for the development of reporting for and participation in all Quality committees.
Interaction and collaboration with various departments within Medicare as well as throughout the enterprise to represent Medicare Medical Management interests.
Responsible for periodic review for adequacy of reporting and when needed, development of operational and managerial reporting sufficient to oversee the day to day business of the departments.
Contribute to ongoing medical management system enhancements and improvements to ensure efficiency and effectiveness of medical management teams.
Provides subject matter expertise for assigned clinical discipline across all LOBs. Finds opportunities to collaborate with Medicaid solutions for scale.
Supervise Market Population Health leaders.
Education/Experience:
Bachelor's degree required in Nursing or healthcare related field. Master's preferred or equivalent work related experience.
Clinical license is required. RN is preferred. LCSW or BH equivalent advanced licensure can be considered.
Minimum of 5 years progressive management experience (including staff management) in a managed care environment.
Minimum of 5 years of experience with Managed Medicare clinical programs.
Minimum of 5 years of experience in case management and utilization management program design and implementation preferred to include experience in setting, communicating and implementing strategic direction.
CCM certification preferred/required within 2 years of hire.
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.
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