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Responsibilities:

This position is responsible for leading and coordinating the clinical quality review process of member concerns and medical records utilizing of care standards. In addition, responsibilities also include supporting the annual medical record review activities including HEDIS and knowledge of Health Plan Rating (HPR). The position also supports accreditation and clinical quality performance improvement activities.

+ Data analysis skills ;- ;intermediate level or above using Excel. ;(sort/pivot tables/de-dup/concatenate / data tools)

+ Project management skills - prep and lead workgroups and meetings. ;Able to manage multiple projects. ;Communicate with different level staff and external vendors.;

+ Critical thinking skills.;;

Work Arrangement: ;

Remote eligible working East Coast time zone. ;

Education/Experience:

+ Registered Nurse strongly preferred.;

+ 3-5 years Managed Care experience required;

+ 3-5 years quality improvement experience required.

+ 2-4 years experience in project facilitation/management role.

+ Proficient with Microsoft Office applications including Word, PowerPoint, Excel required.

+ Knowledge and understanding of QI functions in an MCO preferred.

+ Experience working in MCO / health plan ;- ;Medicaid and Medicare preferred.;

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’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, 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 .

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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.