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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 .

The Community Health Choices (CHC) Home Modification Specialist works within the scope of the service definition for home modifications, which is a service available for Participants with disabilities under the Community Health Choices (CHC) Program. The Home Modification Specialist evaluates Participant needs for home accessibility/modification and the existing residence feasibility for modification. The Home Modification Specialist will assist in comparing scope of work statement submitted by chosen home modification providers. The CHC Home Modification Specialist will work with Participants, contractors, specialists, vendors, and Service Coordinators before, during and after the home accessibility/modification installation process.;

Key Accountabilities and Responsibilities:

+ Evaluate Provider scope of work and proposals for feasibility and quality

+ Applies proficiency with Building Codes, ADA and UFAS Standards

+ Knowledge of and commitment to the Independent Living Philosophy

+ Maintains awareness and complies with Plan CHC authorization timeliness standards based on DHS/NCQA requirements.

+ Provide technical assistance, expertise and consultation for Contractor

+ Apply medical health benefit policy and CHC benefit guidelines to authorize services and appropriately deny services when guidelines are not met.

+ Maintain current knowledge and understanding of the laws, regulations, and policies that pertain to the organizational unit’s business and uses professional judgment in their application.;;

+ Verifies and documents Participant eligibility for services.

+ Receives Home Adaptation referrals for authorization of Long Term Services and Supports available and as defined in the Community Health Choices Program.

+ Documents date that the request was received, nature of request, utilization determination (and events leading up to the determination).

+ Utilize technology and resources (systems, telephones, etc.) to appropriately support work activities. Voice mail as an adjunct to the daily work activities versus major reliance for giving and receiving information from Service Coordinators and Providers.

+ Documents case activities for determinations in enterprise platform systems in a real time manner (as events occur).

+ Provides verbal denial notification to the requesting Service Coordinator and Participant as per policy. Generates denial letter in a timely manner.

+ Adheres to Process Standards, Standard Operating Procedures, and Policies and Procedures, as defined by CHC Agreement (Prior Authorization, Concurrent Review)

+ Assessing and applying Medical Necessity Guidelines as outlined in the CHC agreement for decision making.

+ Consults with Clinical Personnel, when necessary, to ensure the needs of the participant correlate with medical diagnosis

+ Applies submitted information to Plan Community Health Choices (CHC) authorization process (utilizing medical guidelines, Process Standards, Policies and Procedures, and Standard Operating Procedures).

+ Authorizes services in accordance with Home Adaptation benefit guidelines.

+ Coordinates with the referral source if insufficient information is not available to complete the authorization process. Advises the referral source and requests specific information necessary to complete the process. Documents the request and follows Plan CHC process for requesting additional information.

+ Coordinates with Home Modification Providers and Project Managers as needed to ensure open communication, progress and completion of approved Home Modifications.

+ Perform modification assessments of participants homes as needed

+ Travel as determined by manager and/or director to meet the needs of the business

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Education/ Experience:

+ Bachelor’s Degree or equivalent relevant experience

+ 3 – 5 years in building and construction with an in depth focus on defining and providing direction for home modifications for people with disabilities

+ Proficient with ADA accessible design implementation.

+ Ability to research existing ordinances and codes related to design, construction and occupancy

+ Strong Communication and organizational skills required.

+ Ability to manage/oversee multiple projects simultaneously.

+ Background in general contracting or related field of work.

+ Valid driver’s license required; field based position, local travel required;;

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.

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.