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SalaryJob Brief
While this is a remote role, qualified candidates must reside in FL.
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.
The primary purpose of the job is to:
Under the supervision of the Long-Term Care Director, the Long-Term Care Manager is responsible for the direct performance of Case Management, Responsible for compliance with State and Federal laws and business plan goals.
- Plans, organizes, and directs the development and implementation of Case Management. Ensures staff is properly trained, oriented, and provided with regular professional development. Identifies opportunities for improvement, both clinical and administrative, and assists the Director in the strategic planning processes for these functions.
- Coordinates and implements the development of recommended policies and programs. Coordinates, establishes, and monitors achievement of departmental goals and objectives. Responsible for achievement of assigned NCQA standard compliance and compliance with all applicable State and Federal laws.
- Directs effectiveness of existing programs and services, identifies, and evaluates new programs and services to address cost effectiveness, proposed process improvements and to achieve compliance with NCQA standard compliance and compliance with all applicable State and Federal laws.
- Development and management of long-term care operations focusing on improving clinical and financial outcomes, member engagement and satisfaction.
- Participates in and supports the corporate Medical Management Strategy.
- Conduct audits related to departmental compliance with LTSS policies.
- Assists in day-to-day management of the department and participates as internal SME as directed.
- Development of workflows and desk level tools for use in departmental education, training, on-going in-services.
- Coordination of provider, staff and member outreach education and training.
- Prepares, coordinates, and verifies data and reports for the LTSS department.
- Assures that outbound and inbound data is QA’d and prepared for submission timely.
- Maintains and presents key metrics to departmental leadership routinely as directed.
- Provides oversight of the transitional services function within the department.
- As needed in new business situations, assumes lead role in phasing in State’s Medicaid Long Term Care Service system, roles and responsibilities.
- Directs the coordination of positive inter and intra communication to share information regarding quality of care, member issues and cost-effective services. Works across departmental lines to achieve objectives.
- Creates and supports an environment that fosters teamwork, cooperation, respect and diversity. Establishes and maintains positive communication and professional demeanor with ACFL employees, providers and acts as liaison with outside entities as required.
- Demonstrates and supports commitment to corporate goals and mission.
- Performs other related duties and projects as assigned.
Education/Experience:
- Bachelor’s degree in Social Work or in a human service, social science, or health field with a minimum of 5 years of experience in Case Management, 2 years of which shall be related to the elderly and disabled populations.
- Master’s Degree in a human service, social science, or health field preferred. Minimum of 5 years of experience in Case Management, 2 years of which shall be related to the elderly and disabled populations.
- 8+ years progressive experience in healthcare delivery required with at least 5 years of experience in managed health care.
- Minimum of 5 years managerial experience required including hiring, training, and performance management.
- Minimum of 1 year project management experience required preferably at management level.
- Thorough knowledge of FL Long Term Care and Home and Community Based Services (HCBS) contract guidelines, rules, and requirements.
- 2+ years of managed Medicare experience preferred. 1+ year of managed Medicaid experience preferred.
- Ability to interact with health care professionals in a professional manner.
- Ability to provide informed advocacy.
- Knowledge of and experience working with persons with complex care needs including mental health and chronic conditions.
- Knowledgeable in preparation of educational materials, presentations, and overall adult learning methodologies.
- Knowledgeable in basic data analytics as related to aggregating, distinguishing, and displaying data for reporting purposes.
- Excellent organizational, analytical and interpersonal skills required.
- Ability to develop and design programs to address cost efficiencies and quality health outcomes.
- Ability to develop and maintain operational budget.
- Excellent written and verbal communication skills.
- Proficient PC skills in a windows based environment.
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.
