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

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.

Responsibilities:

Act as a quality coach and/or mentor to develop operational staff capabilities regarding Quality; drive ownership of quality so that it directly impacts operational performance outcomes.

• Work actively with operational and functional areas to improve their operational controls, including the ongoing review of controls and their effectiveness
• Perform daily audits of associates' interactions and compile related quality reporting to management
• Train associates on standard quality protocols, including ad-hoc one-to-one coaching
• Recognize the need for intervention due to deviation from policy and procedures, and escalate for appropriate remediation
• Recommend continuous improvement plans based on observations to management and offer procedural recommendations based on identified risks and trends to support continuous improvement
• Conduct regular monitoring of the knowledge tool; report results and recommend enhancements to the associate reference material
• Develop quality assurance programs and conduct refresher training, as needed
• Maintain a thorough knowledge of appropriate standard operating procedures, contractual, and regulatory requirements
• Perform other functions as necessary or as assigned

This is a remote position

Education/Experience:

• High School Diploma or equivalent required
• Bachelor's Degree in Business, Health Care Administration, Public Health, and/or related discipline preferred
• Requires:
  • Minimum five (5) years in an HMO and/or pharmacy setting with current/recent experience on Medicare products, such as Medicare Part D
  • Minimum two (2) years of current/recent supervisory experience
  • Working knowledge of PBM operations
  • Call center or customer service quality monitoring knowledge and quality improvement concepts, policies, and procedures
  • Experience with data reporting and analytics
• Experience with CMS Stars Ratings preferred
• Verint 360 experience preferred

This is a remote position

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 include remote options, hybrid work schedules, 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.