Qualified candidates must live in the state of Pennsylvania. 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. We'd like to hear from 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 www.amerihealthcaritas.com.
Responsibilities:
The SCE (Service Coordination Entities) Coordinator is responsible for the direct oversight and monitoring of external Service Coordination entities by the AmeriHealth Caritas Pennsylvania Community HealthChoices model of care.
- Conduct audits of external Service Coordination Entities
- Facilitate training sessions with external Service Coordination Entities
- Provide oversight of the delegated responsibilities of external Service Coordination
- Conduct monitoring calls and regular oversight meetings with external Service Coordination Entities’ leadership teams
- Serve as a liaison between external Service Coordination and various internal teams
- Provide oversight to external Service Coordination Entities to ensure quality and performance metrics are met
- Measure the effectiveness and efficiencies of external Service Coordination Entities and utilize trends to address inconsistencies and opportunities.
- Coordinate meetings between external Service Coordination Entities and internal Utilization Management team for clinical and case consultation
Education/Experience:
- Bachelor’s Degree
- Minimum of 3 years working in social services or healthcare-related field.
- Valid driver's license required.
Other Skills:
- Experience working with people in need of LTSS.
- Knowledge of the home and community-based service system and how to access and arrange for services
- Experience conducting LTSS needs assessments and monitoring LTSS delivery.
- Ability to provide informed advocacy
- Experience in partnering with, influencing, and collaborating closely with external Service Coordination Entities or similar organizations
- Experience in assessing and determining the needs of external partners
- Experience in contract compliance and oversight
- Ability to interact professionally with healthcare professionals and state and community partners.
- Expertise and experience with Critical Incidents.
- Knowledge of MS Suite with emphasiss on Excel.
Work Arrangement:
- Candidates must live in Pennsylvania.
- Remote role with occasional travel within Pennsylvania.
Our Comprehensive Benefits Package Flexible work solutions include remote options, hybrid work schedules, competitive pay, paid time off, holidays and volunteer events, health insurance coverage for you and your dependents on Day 1, 401(k) tuition reimbursement, and more.
