Homeoffice Coordinator Clinical Liaison/Special Needs at AmeriHealth Caritas

Under the Supervision of the Integrated Healthcare Management Manager, the Clinical Liaison/Special Needs Coordinator is responsible for identifying, assessing, planning, coordinating, and implementing appropriate cost-effective and quality healthcare services for individuals requiring additional assistance to access special needs services.  Acts as a liaison between Health Plan and Regulatory agency.  Works collaboratively with all Health Plan departments and providers to facilitate cost-effective care.  

• Acts as a liaison between Regulatory agency, Health Plan, special needs members, caregivers, healthcare providers and payors.
• Investigates and assists in the resolution of issues referred to Health Plan from the Medicaid agency including, but not limited to:  Pharmacy, Claims, member appeals, medical and dental provider network issues, care delivery, access to care, expedited enrollment, staffing needs for pediatric shift care/private duty nursing, residential and long term placement for special needs members.
• Participates in meetings (some may be in-person), conference calls, and case discussions with government agencies and/or providers including, but not limited to:  on site Special Needs Monitoring meeting, Joint Treatment Plan Conferences, PH-MCO/BH-MCO meetings, Juvenile Court Services and Integrated Health Homes (IHH).
• Collaborates with Statutory Reporting and Medical Informatics in the preparation and review of monthly Special Needs reports.  Provides monthly reports and analysis of operations and services as required by departmental guidelines and regulatory requirements.
• Functions as liaison with Community and other health care providers.  Supports and assists providers and advocates for Special Needs members with resolving question about access to benefited care and services.
• Supports IHCM staff as they intermediate between member, caregivers, PCP, specialist and providers in resolution of issues affecting both individual members or Special Needs populations. Monitors and coordinates reporting of resolution of issues to the Medicaid or other responsible government agency
• Performs other duties an projects as assigned.

Work Arrangement: Remote, must be local to the Philadelphia area 

Education/ Experience: 

• Bachelor’s Degree.
• Registered Nurse or MSW
• Valid driver’s license.
• Case Management Certification required.
• 3 years' experience dealing with special needs populations such as Medicaid.  
• 5yr clinical nursing or behavioral experience.
• Ability to attend in person meetings 

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.