Role Overview:

Under the direction of the designated Supervisor/Manager, the Care Connector provides 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. The incumbent 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 supports program interventions of the care management department. The incumbent 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 Care Connector utilizes 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. The Care Connector assists the 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.

Work Arrangement: Remote

Responsibilities:

• Support, identify, and communicate directly with Members to identify needs and provide information on health care access, preventative health interventions, and screening
• Support the Members with non-clinical functions such as, but not limited to, identifying, and linking to community resources, and scheduling appointments 
• Perform 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 the AmeriHealth Caritas Family of Companies (ACFC) electronic care management platform
• 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 in accordance with required standards and within respective timeliness guidelines; refer to the appropriate clinical team members for review as defined by the workflow 
• Appropriately process or triage calls from Members and Providers, as well as processing urgent scanning, mailing requests, and documentation retrieval as applicable
• Demonstrate a professional and courteous manner when communicating with others, and clearly and accurately state the agreed-upon resolution 
• Comply with ACFC and HIPAA confidentiality standards to protect the confidentiality of Members' information 
• Adhere to ACFC Policies & Procedures, process standards, Standard Operating Procedures, and maintain current knowledge of Members' benefits, rights, and responsibilities, and support the ACFC Mission & Values
• Perform other related duties and projects as assigned within the identified timeframes

Education/Experience:

• High School Diploma or equivalent required
• Minimum of two (2) years of current/recent work experience in a healthcare environment required
• Minimum of one (1) year of current/recent telephonic customer service experience required, preferably within a healthcare setting
• Managed care experience preferred  
• Medical terminology, ICD, CPT, and/or coding experience preferred
• Strongly prefer Medical Assistant, Home Health Aide, Nursing Assistant, or other similar health care para-professional training or certification
• Prior member service or customer service telephone experience desired
• Prior behavioral health experience is a plus

Skills & Abilities:

• Proficient PC skills in a Windows-based environment, MS Office products, including word processing, spreadsheets, and database programs
• Excellent interpersonal and verbal communication skills and the ability to write clear and concise reports
• Working knowledge of policies, standard operating procedures, workflows, Members' insurance products and benefits, NCQA and regulatory requirements, along with community resources, programs, and the Electronic Visit Verification system
• Attention to detail and confidentiality with strong organizational skills 

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, 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

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 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.