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Applicants must reside in Michigan.

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. We want to connect with you if you're going to make a difference.

Headquartered in Newtown Square, PA, 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.

Responsibilities:

Under the direction of the designated Supervisor/Manager, this position is responsible for providing select program interventions according to established health management program guidelines and the Member population. The Care Connector functions with direction from the program’s Case Managers or Supervisor/Manager and is responsible for screening identified Members based on the program's plan stratification. The Care Connector interacts with Members, providers, and other AmeriHealth Caritas Family of Companies staff to implement program interventions, document activities, and refer risk-appropriate Members to professional/licensed staff according to protocols.;

The Care Connector is also responsible for supporting program interventions of the care management department. Associates will utilize good communication and listening skills, including Motivational Interviewing, to conduct both inbound and outreach calls and collect data according to scripts as applicable. The associates will utilize scripts, tools, and protocols to meet the identified productivity and performance expectations. The Care Connector may perform process calls from Members, providers, and other internal and external departments within the company. The Care Connector elicits information from Members through surveys and questionnaires provided by the care management platform. It identifies Members with Care Gaps/HEDIS-related health conditions and social determinants of health needs. This associate will assist these Members in accessing care through health plan benefits and community resources. Under the direction of the Care Management staff, the Care Connector may provide Members with educational materials and carry out strategies to increase treatment adherence and reduce barriers to care.

+ Supports, identifies, and communicates directly with Members to identify needs and provide information on health care access, preventative health interventions, and screening.

+ Supports the Members with non-clinical functions such as identifying and linking to community resources and scheduling appointments.;

+ ;Performs research using the internet and processed claims to identify alternate phone numbers from providers, pharmacies, and other care team members.

+ ;Develop a working knowledge and maintain timely, complete, and accurate documentation of Members' interactions in the AmeriHealth Caritas Family of Companies (ACFC) electronic care management platform.

+ The Care Connector will have working knowledge of policies, standard operating procedures, workflows, Members' insurance products and benefits, NCQA and regulatory requirements, community resources, programs, and the Electronic Visit Verification system.

+ As applicable, support daily workflows emphasizing a positive workplace environment, through concise and timely interactions with staff, facilities, vendors, and providers to support our culturally and demographically diverse Member population.

+ May process, maintain, and close all incoming and outgoing correspondence/faxes by required standards and within respective timeliness guidelines. Refers to the appropriate clinical team members for review as defined by workflow.;

+ Appropriately processes or triages calls from Members and providers, and processes urgent scanning, mailing requests, and documentation retrieval as applicable.

+ Demonstrates a professional and courteous manner when communicating with others, with the ability to state clearly and accurately the agreed-upon resolution.;

+ Complies with ACFC and HIPAA confidentiality standards to protect the confidentiality of Members' information.;

+ Adheres to ACFC Policies & Procedures, process standards, Standard Operating Procedures, and maintains current knowledge of Members' benefits, rights, and responsibilities, and supports the ACFC Mission & Values.

+ ;Performs other related duties and projects as assigned within the identified timeframes.

Education/Experience:

+ High School Diploma or GED required. An associate's degree is preferred.

+ A minimum of 2 years of work experience in a healthcare environment is required.

+ A minimum of 1 year of telephonic customer service experience is required, preferably within a healthcare setting.

+ Medical terminology experience preferred.;

+ Training and/or certification as a medical assistant, home health aide, nursing assistant, or other healthcare paraprofessional preferred.

+ Excellent interpersonal and communication (listening, verbal, and written) skills, including keeping accurate and timely records and documenting according to established processes.

+ Knowledge of MS Office (Word, Excel, Outlook, Teams) and SharePoint in a Windows-based environment is preferred.

+ Experience working within electronic medical record database programs is preferred.

Diversity, Equity, and Inclusion

At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable being 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, 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.