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. If you want to make a difference, we would like to connect with you.

Headquartered in Newtown Square, PA, 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:

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 Plan stratification for the program. 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 both productivity and performance expectations as identified. The Care Connector may perform process calls from Members, providers, and other departments both internal and external to the company. The Care Connector elicits information from Members through surveys and questionnaires provided by the care management platform and 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 adherence to treatment and reduce barriers to care.

• Supports, identifies, communicates directly with Members to identify needs and provide information on health care access and preventative health interventions and screening.
• Supports the Members with non-clinical functions such as, but not limited to, 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 members of the care team.
•  Develop a working knowledge and maintain timely, complete, and accurate documentation of Members interactions in 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, along with community resources, programs and Electronic Visit Verification system.
• As applicable, support daily workflows with an emphasis on 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 correspondences/faxes in accordance with 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 as well as processing 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 HIPPA 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 support the ACFC Mission & Values.
•  Performs other related duties and projects as assigned within the identified timeframes.

Education/Experience:

• High School Diploma or GED required. Associate degree preferred.
• Minimum of 2 years of work experience in a healthcare environment required.
• Minimum of 1 year of telephonic customer service experience 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 similar health care paraprofessional preferred.
• Excellent interpersonal and communication (listening, verbal, and written) skills, including the ability to keep accurate and timely records and document according to established processes.
• Proficiency utilizing MS Office (Word, Excel, Outlook, Teams), SharePoint in a Windows-based environment preferred.
• Experience working within electronic medical record database programs preferred.

Additional Qualifications:

To provide our Members with the best experience, we look for employees who can communicate with our Members in their preferred spoken language. In addition to English, the following are our Members most common languages:

• Spanish, Arabic, Haitian/Creole, Russian, Mandarin, Vietnamese
   

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.