"Alerted.org

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, 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

Responsibilities:

+ Ensures the data integrity of various pharmacy data sources and interprets results into recommendations.

+ Analyzes, researches, and interprets pharmacy data to identify potential issues, trends, and areas of interest that require greater focus. Utilizes real-time reports to proactively identify and mitigate risks. Makes recommendations to management based upon trend analysis and compliance metrics. Reviews and writes comprehensive reports.

+ Independently manages multiple projects for the subsequent creation of standard queries and reporting.

+ Demonstrates and maintains a general understanding of the company’s related legacy systems as well as other data collection and processing systems

+ Facilitates work sessions with Vendors and the IS Solutions Department as needed to research issues, perform root cause analysis to resolve issues, support implementations, and integrate medical and pharmacy data.

+ Identify, research, and analyze data outliers and/or irregularities in operations reports.

+ Monitor, manage, and audit monthly data submissions, ensuring timely and accurate submissions

+ Supports standard and ad hoc reporting requests to tightly manage the plan's utilization and cost; this includes any urgent requests that could be received internally from management or externally from the state.

+ Reviews, supports, and troubleshoots pharmacy benefits to ensure accurate pharmacy coverage and continuity of care.

+ Create and support an environment that fosters teamwork, cooperation, respect, and diversity.;

+ Establishes and maintains positive communication and professional demeanor with internal and external business partners at all times.

+ Performs other related duties as assigned. _;_

+ Attends required training on an annual basis.

+ Adheres to ACFC policies and procedures.

+ Regularly reviews and adheres to standard operating guidelines, desktop procedures, checklists, templates, and memorandums issued to the department.

Education/Experience:

+ High School Diploma or equivalent **required**

+ Bachelor’s degree preferred

+ Active/current National Pharmacy Technician Certification (NHA or PTCB) preferred

+ Minimum **one (1) year** of current/recent **Pharmacy Benefit Manager (PBM)** , **Medicare** , **Medicaid** , and/or compliance experience **required**

+ Claims knowledge and/or experience is a plus

+ Skills using Excel, Access, SQL, and SAS are **required** for data manipulation, analysis, and reporting

+ Azure Databricks experience is preferred

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.

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.