Qureos Mentor

AmeriHealth Caritas

<div>For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.
Your career starts now. We&rsquo;re looking for the next generation of health care leaders.
At AmeriHealth Caritas, we&rsquo;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&rsquo;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.
The Care Connector is responsible for supporting the daily operations of integrated care management and utilization management program interventions. The Care Connector performs in a contact center environment, effectively processing calls from Members, Providers, and other areas, internal and external to the company. Under the direction of Clinical staff, the Care Connector will provide members with educational materials and carry out strategies to increase healthcare adherence and reduce barriers to care.
Education/Experience:<ul><li>
High School Diploma or equivalent required</li><li>
Minimum of two (2) years of work experience in a healthcare environment required</li><li>
Minimum of one (1) year of telephonic customer service experience required, preferably within a healthcare setting</li><li>
Managed care experience preferred</li><li>
Medical terminology, ICD, CPT, and/or coding experience preferred</li><li>
Strongly prefer Medical Assistant, Home Health Aide, Nursing Assistant, or other similar health care para-professional training or certification</li><li>
Prior member service or customer service telephone experience desired</li><li>
Prior behavioral health experience is a plus</li><li>
Excellent interpersonal and verbal communication skills and the ability to write clear and concise reports</li><li>
Attention to detail and confidentiality with strong organizational skills</li></ul>
Skills &amp; Abilities:<ul><li>
Proficient PC skills in a Windows-based environment, MS Office products, including word processing, spreadsheets, and database programs</li></ul>
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.</div>

Care Connector

<div>For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.
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, 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:
The Clinical Case Manager assists members who are eligible for LTSS in obtaining the services they need as required by DSHP Plus LTSS in New Castle county. He or she contributes to the LTSS case management process by performing telephonic and/or face-to-face assessments for the identification, evaluation, coordination and management of member&rsquo;s needs, including physical health, behavioral health, social services and long term services and supports. This position is also responsible for completing Level of Care Redeterminations for home and community based members annually. This requires clinical review when evaluating the need for a member to remain in the program. The Clinical Case Manager will also provide clinical support to his/her non-licensed counterparts and may act as a secondary case manager when a member is experiencing an acute episode.<ul><li>
Coordination of care for medically complex LTSS Members receiving private duty nursing (PDN)</li><li>
Performs follow-up on outstanding items of need and maintains a calendar or PDN Coverage.</li><li>
Establish communication method to effectively communicate with multiplePDN agencies and member/member representative.</li><li>
Coordinates and collaborates with prior authorization team to make sure all necessary precertifications for required services are submitted for review. Assists in obtaining the Letter of Medical Necessity (LOMN) as needed</li><li>
Coordinate with provider network team in the utilization of non-contracted providers or facilities as necessary following the single case agreement (SCA) process</li><li>
Conducts reevaluation of level of care annually or more frequently as needed in accordance with DSHP Plan Plus LTSS requirements.</li><li>
Provides clinical support to non-licensed case managers as needed.</li><li>
Conduct condition specific assessments with members with chronic conditions. Provide education and routine follow-up with member.</li><li>
Perform initial clinical assessment of new members, develop care plan, and initiate services.</li><li>
Facilitate person-centered planning team meetings to coordinate care and services. Identify, coordinate, and assist participants in gaining access to needed LTSS and other Covered Services, as well as non-covered medical, social, housing, educational, and other services and supports.</li><li>
Provides information to participants and conducts monitoring of authorized services and supports for Participants.</li><li>
Informs participants about available LTSS required needs assessments, the care plan process, service alternatives and service delivery options.</li><li>
Informs participants of their rights and responsibilities as well as assists with the complaint, grievance, and DHS Fair Hearing process.</li><li>
Collects additional necessary information, including participant preferences, strengths, and goals to inform the development of the Plan of Care.</li><li>
Conducts comprehensive needs assessments annually or more frequently as needed in accordance with requirements.</li><li>
Review and acting upon worklists in Jiva, including monitoring of new members</li><li>
Authorize urgent services when needed</li><li>
Monitoring critical incident reporting/documentation, recommending/taking action w/ other corporate entities as required</li><li>
Liaison activities with Physical health Care Coordination program</li><li>
Working with LTSS and DSNP members to complete comprehensive assessments, care plans, medication reconciliation, monitoring follow-up and progress, and assisting with discharge planning/transitions of care.</li></ul>
Education/Experience:<ul><li>
Delaware licensed RN required.</li><li>
Ability to travel throughout entire state of DE.</li><li>
Valid driver&rsquo;s license required</li><li>
Knowledge of the home and community-based service system and how to access and arrange for services</li><li>
Experience conducting LTSS needs assessments and monitoring LTSS delivery</li><li>
Ability to provide informed advocacy</li><li>
Ability to interact with members face to face</li><li>
Ability to interact with health care professionals in a professional manner</li><li>
Ability to travel up to 75%</li><li>
Duties may include case management responsibilities based on business needs. This role is also a part of the contingency plan, where a caseload may be assigned in the event of a staffing need</li></ul>
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.</div>

Clinical Case Manager DE Long Term Services & Support-Private Duty Nursing

<div>THIS IS A HYBRID, OFFICE BASED POSITION WORKING AT OUR ELLIS PRESERVE OFFICE LOCATED IN NEWTOWN SQUARE, PA.
WE WILL NOT CONSIDER REMOTE CANDIDATES!
Role Overview
We are seeking an Azure Data Engineer with an extensive background in building data pipelines using Azure Data Factory and Databricks to join our growing Enterprise Data Office. You will be designing and implementing optimal data pipelines/flows from multiple sources; experience with Snowflake and Azure Synapse is a plus.. If you are a confident, skilled, and energetic professional and can complement a blended team, we want to meet you.
Responsibilities<ul><li>
Build and maintain scalable automated data pipelines. Support critical data pipelines with a highly scalable distributed architecture - including data ingestion (streaming, events and batch), data integration, data curation.
</li><li>Strong experience as an Azure Data Engineer and must have Azure Databricks and Azure Data Factory experience.</li><li>
Demonstrated experience of turning business use cases and requirements into technical solutions.</li><li>
Expert level understanding on Azure Data Factory, SQL, ADLS, Azure Databricks, PySpark, Azure DevOps, Kafka, Python is required.</li><li>
Experience in business processing mapping of data and analytics solutions.</li><li>
Ability to conduct data profiling, cataloging, and mapping for technical design and construction of technical data flows.</li><li>
The ability to apply such methods to solve business problems using one or more Azure Data and Analytics services in combination with building data pipelines, data streams, and system integration.</li><li>
HVR, Snowflake, Azure Synapse, SQL Server, Collibra Governance tools is a plus.</li><li>
Experience preparing data for Data Science and Machine Learning.</li><li>
Experience preparing data for use in Azure Databricks.</li><li>
Demonstrated experience preparing data and building data pipelines reusable components and frameworks.</li><li>
Identify, design, and implement internal process improvements: automating manual processes, optimizing data delivery, re-designing infrastructure for greater scalability, etc.</li><li>
Work with stakeholders including the Product, Data and Design teams to assist with data-related technical issues and support their data needs.</li><li>
Identify and tackle issues concerning data management to improve data quality.</li><li>
Understand and implement best practices in management of data, including master data, reference data, metadata, data quality and lineage.</li><li>
Strong knowledge of Dev-Ops processes (including CI/CD) and Infrastructure as code is essential.</li><li>
Strong team collaboration and experience working with remote teams.</li><li>
Experience with Git/TFS/VSTS is a must.</li></ul>
Education and Experience<ul><li>
At least five (5)+ years of experience with Azure Data Engineering.</li><li>
At least four (4)+ years of hands-on experience in Azure Databricks and Azure Data Factory.
</li><li>At least five (5)+ years of experience programming in Python, PySpark, Scala, Shell, T-SQL etc.</li><li>
Experience as Data Engineer in Azure Big Data Environment.</li><li>
Expertise in ETL tools i.e. (SSIS, Data Stage).</li><li>
Expertise in Implementing Data Warehousing and Data Lake Solutions.</li><li>
Experience with working in Agile environment as part of a scrum team.</li><li>
Hands-on experience in Azure stack and hands-on experience on HVR, Kafka and Snowflake.</li><li>
Good understanding of Azure Databricks platform and ability to build data analytics solutions to support the required performance &amp; scale.</li><li>
Good understanding and experience working on Deltalake using Apache Delta and Unity Catalog in Azure Databricks.</li><li>
Experienced working on performance tuning and optimizing long running jobs.</li><li>
Demonstrated analytical and problem-solving skills, particularly those that apply to a big data environment.</li><li>
Solid understanding of Modern Data Warehouse and Data Warehousing concepts.</li><li>
Proficient in a source code control system.</li><li>
Bachelor&rsquo;s degree in technology, related field or equivalent combination of education and relevant work experience.</li></ul>
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, 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.</div>

Azure Data Engineer

<div>Role Overview
In this role, you will provide daily operational leadership to a team of 13 remote Utilization Management Technicians. This team supports the intake of physical health utilization management reviews specific to First Choice by Select Health of South Carolina. As one of 6 Supervisors, Utilization Management Review Non Clinical, you will ensure all processes are completed and deadlines are met and in compliance with local, state, and federal regulatory standards.
<ul><li>Provides technical assistance and coaching to staff in a prompt and ongoing basis to ensure accuracy and completion of work according to regulatory guidelines, AmeriHealth Caritas policies, procedures, and process standards.</li><li>
Identifies the need for and develops policies and procedures, and training and education plans to assure that Care Connector or other pertinent staff process standards are clearly documented, and meet/support organizational goals.</li><li>
Maintains a current knowledge base of Intake or other appropriate staff processes and trains/ mentors staff.</li><li>
Works collaboratively with Utilization Management Supervisors, Managers and Directors to identify and resolve workflow issues and obstacles to efficient departmental and individual performance.</li><li>
Maintains current knowledge of all Utilization Management initiatives, attends assigned meetings and actively communicates with departmental representatives Intake staff or pertinent staff work duties and participates in the development of Policies &amp; Procedures, Standard Operating Processes, Training development and presentations to direct reports and other departments</li><li>
May utilize work force management systems, as dictated by leadership, to effectively monitor the processing of inbound calls/ contacts. Responsible for preparing reports and conducting analysis of UM Technicians or pertinent staff productivity and attainment of goals. Performs other related duties and projects as assigned.</li></ul>
Education/Experience:<ul><li>
High School Diploma or GED required; Associate's Degree preferred</li><li>
Minimum of 3 years experience supervising staff in a contact center environment with processes to provide accountability in high volume call environment, preferred working in a health care/managed care environment.</li><li>
Strong knowledge base of health care resources, ideally with managed care experience.</li><li>
Excellent communication skills, oral written; excellent listening skills.</li><li>
Solid knowledge of contact center processes to provide accountability in high volume call environment, managing audits/reports.</li><li>
Demonstrated ability to promote excellent customer service skills.</li><li>
Skill in working with diverse teams and ability to collaborate with various disciplines within a market or Plan is highly desirable.</li></ul>
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.</div>

Non Clinical Intake UM Review Supervisor

Join AmeriHealth Caritas and explore 4   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

AmeriHealth Caritas

About Company

Care Connector

Clinical Case Manager DE Long Term Services & Support-Private Duty Nursing

Azure Data Engineer

Non Clinical Intake UM Review Supervisor