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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 .

The Director of ICT Care Coordination Population Health provides leadership, direction, and administration of operations to ensure appropriate services and support to health plan members. Working in collaboration with the Market Chief Medical Officer (CMO) and the Population Health Director, the Director of ICT Care Coordination Population Health has responsibility and accountability for the function, activities, and practices of clinical and non-clinical staff. It is responsible for market-specific clinical operations, supervising care coordination staff, and ensuring all market activities meet the state-mandated requirements and align with enterprise program descriptions, policies, and procedures.

Responsibilities:

• Develop and maintain a collaborative working relationship with the CMO, informing the Population Health goals and strategy.

• Partner with the Population Health Director to ensure the Population Health goals and strategy are successfully executed and monitored.

• In collaboration with the CMO, Population Health Market Directors, and Quality Director, engage in continuous quality and process improvement activities on existing care coordination programs and new initiatives.

• Overseeing, executing, and managing market-specific clinical programs, including UM, CM, RROT, and Bright Start.

• Assure compliance of program execution with population health strategy and alignment with enterprise policies and contracts.

• Supervise market-specific Care Coordination- Integrated Care Clinical Operations staff and facilitate growth and professional development of the case/coordination team. Planned and maintained appropriate staffing levels; assisted in interviews to select qualified candidates.

• Responsible for market-specific contract and accreditation compliance related to Care Coordination -Population Health Clinical Operations and oversight of the ODM contract 42 CFR 438.208 to include but not limited to:

• Implement mechanisms for identifying, assessing, and developing treatment plans for members with special health care needs.

• Ensure access to primary care, behavioral health, and coordination of care services for all members.

• Serve as an MCO's primary point of contact for the State regulatory agencies on care coordination and similar functions.

• Develop and implement processes and resources for supporting members who opt out of care coordination.

• Coordinate services furnished to the member with the services the member received from any other health care entity, and;

• Ensure care coordination and disease management are part of the population health and QI activities when appropriate.

• Accountable for implementing effective and continuous programs to measure, assess, and improve health outcomes and performance.

• Monitor activities related to transition of care and care coordination quality improvement.

• Monitor LOB performance metrics and ensure appropriate action is taken to address performance opportunities consistent with state-mandated requirements and enterprise policies. ;

• Serve as liaison with enterprise, sharing goals and objectives of LOB/Market and seeking to share best practices to and from the market to the enterprise.

• Direct communication with State and other county primary contractors concerning clinical services, policies, and performance in collaboration with Program Managers.

• Prepare meeting materials, monthly Market CM KPI reports, communications, planning, coordinating, and keeping the meeting contents focused.;

• Collaborate with Market and Corporate Regulatory, EQRO, NCQA, and QAPI.

• Coordinate with the management team to provide detailed and accurate reports on Care Coordination utilization, service delivery, and member treatment.

• Lead SME for Procurement focused on Care Coordination/Care Management (RFP/RFI) and consult Population Health Growth for new markets.

Education/Experience:;

• Master’s Degree required.

• Registered Nurse, must be licensed in the state of Ohio.

• LCSW or BH equivalent advanced licensure can be considered. Social workers must have an MSW. CCM certification is required (CCMC-Ohio contract language).

• Minimum of 3 years experience with NCQA and related guidelines.

3 to 5 years of experience:

• Progressive management experience, (including staff management) in a managed care environment.

• Case Management experience.

• Program Management experience preferred.

• CM program design and implementation preferred. Should include experience in setting, communicating, and implementing strategic direction.

Minimum of 5 years experience:

• In a Medicaid managed care environment preferred.

• Supervisory background and/or experience.

• Travel required.

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 implement these principles daily 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, holidays and volunteer events, health insurance coverage for you and your dependents on Day 1, 401(k) tuition reimbursement, and more.

As a company, we support internal diversity through:

Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.