• Job Description

  Req#: 38491

  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, 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 www.amerihealthcaritas.com

  Summary:

  Under the direction of the Designated Manager, this position provides select program interventions according to established health management program guidelines and the Member population. The Care Connector functions with direction from the program’s Manager, and screens identified Members based on the program's plan stratification. The incumbent interacts with Members, Providers, and other AmeriHealth Caritas Family of Companies staff to implement program interventions, document activities, and refer risk-appropriate Members to professional staff according to protocols.

  The Care Connector also supports program interventions of the care management department. Such associates will use good communication and listening skills to conduct both inbound and outreach calls, collect data according to scripts as applicable, and script, tools, and protocols to meet both productivity and performance expectations as identified.

  The Care Connector may perform in a contact center environment, effectively processing calls from Members, Providers, and other departments both internal and external to the company. The Care Connector elicits information from Members through surveys and questionnaires provided by the care management platform and identifies Members with Care Gaps/HEDIS-related health conditions and social determinants of health needs. The incumbent will assist these Members in accessing care through health plan benefits and community resources. Under the direction of the Program Excellence staff, the Care Connector may provide Members with educational materials and carry out strategies to increase adherence to treatment and reduce barriers to care.

  Responsibilities:

  • Supports, identifies, and communicates directly with Members to identify needs and provide information on healthcare access and preventative health interventions and screenings. Supports Members with non-clinical functions such as, but not limited to, identifying, and linking to community resources, and scheduling appointments

  • Performs research using the internet and processed claims to identify alternate phone numbers from providers, pharmacies, and other members of the care team

  • Develops a working knowledge and maintains timely, complete, and accurate documentation of Members' interactions in AmeriHealth Caritas Family of Companies (ACFC) electronic care management platform, policies, standard operating procedures, workflows, Members’ insurance products and benefits, NCQA and regulatory requirements, along with community resources, programs, and Electronic Visit Verification system

  • As applicable, support daily workflows with an emphasis on a positive workplace environment, through concise and timely interactions with staff, facilities, vendors, and providers to support our culturally and demographically diverse Member population

  • May process, maintain, and close all incoming and outgoing correspondences/faxes in accordance with required standards and within respective timeliness guidelines. Refers to the appropriate clinical team members for review as defined by workflow

  • May perform in a call center environment, appropriately processing or triaging calls from Members and Providers as well as processing urgent scanning, mailing requests, and documentation retrieval as applicable

  • Demonstrates a professional and courteous manner when communicating with others with the ability to state clearly and accurately the agreed-upon resolution

  • Complies with ACFC and HIPPA confidentiality standards to protect the confidentiality of Members' information

  • Adheres to ACFC Policies and Procedures, process standards, Standard Operating Procedures and maintains current knowledge of Members' benefits, rights, and responsibilities, and supports the ACFC Mission & Values

  • Performs other related duties and projects as assigned within the identified timeframes

  Available Schedules (all Eastern Standard Time):

  8:30 a.m. - 5:00 p.m. Monday thru Friday

  9:00 a.m. - 5:30 p.m. Monday thru Friday

  10:30 a.m. - 7:00 p.m. Monday thru Friday

  Education/Experience:

  · High School Diploma or equivalent required; Associate Degree preferred

  · Minimum one (1) year of current/recent telephonic customer service required

  · Minimum two (2) years of current/recent work experience required; healthcare setting preferred

  · Medical call center work experience in a production/metric-driven environment preferred, preferably in a healthcare setting

  · PC skills - preferably in a Windows-based environment - including word processing, spreadsheets, and working in Electronic Health Records database programs

  · Documentation skills - ability to keep accurate and timely records and documentation according to established processes.

  · Working knowledge of Plan Benefits and Services preferred

  · Strongly prefer Medical Assistant, Home Health Aide, Nursing Assistant, and/or other similar healthcare para-professional training or certification

  · Behavioral health experience a plus

  · Member service or customer service telephone experience desired

  · Bilingual preferred

  · Medical terminology, ICD, CPT, and/or coding experience preferred

  Diversity, Equity, and Inclusion

  At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable being 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 include remote options, hybrid work schedules, competitive pay, Paid Time Off (PTO), holidays and volunteer events, health insurance coverage for you and your dependents on Day 1, 401(k), tuition reimbursement, and more.

• About the company

  AmeriHealth Caritas is a different kind of health care company. Our goal is to provide responsible managed care solutions, including Medicaid, Medicare, and CHIP — plus pharmacy benefit management, behavioral health, and administrative services.

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