AmeriHealth Caritas Coordinator, Delegation Oversight in Philadelphia, Pennsylvania

Coordinator, Delegation Oversight

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 Philadelphia, 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 .


Description

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 Philadelphia, 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:

This position will interface with the delegated provider groups, complete required auditing and reporting related to provider/subcontractor delegation, and ensure adherence with NCQA, URAC, and/or state, federal and business requirements. The selected candidate will conduct provider delegation audits; serve as the key contact for communications and functional interface with the delegated entities; ensure compliance with performance metrics.

· Assist in managing policies and procedures relating to credentialing and provider delegation maintenance.

· Assist with Credentialing/Quality Committee activities.

· Interface with the health plan's functional departments to address any service related issues.

· Report audit outcomes and delegation monitoring results to management.

· Facilitate monthly Vendor Partnership meetings with key stakeholders and subcontractor representatives.

· Responsible for the development, implementation and monitoring of Corrective Action plans, when needed.

· Use critical thinking and problem solving skills to help ensure successful delegation partnerships and department quality.

Qualifications/Skills/Abilities:

  • Bachelor's Degree..
  • Minimum of 2- 4 years’ experience in credentialing, delegation or relevant provider data experience.
  • 50% to 75% overnight travel; candidates must have a valid driver's license and car insurance.

EOE Minorities/Females/Protected Veterans/Disabled