Job 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 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.
Candidates must reside in the State of South Carolina and be within a commutable distance of Charleston, SC and the SC State House in Columbia, SC
The Market Clinical Director of Population Health is responsible for market-specific clinical operations, supervising prenatal UM and ICM staff, and ensuring all market activities conform to enterprise program descriptions, policies, and procedures.
• Oversight of execution of market-specific clinical programs including prenatal UM, CM, and Bright Start.
• Assures compliance of program execution with enterprise policies
• Monitors performance metrics across multiple LOBs and assures that appropriate action is taken to address performance opportunities consistent with enterprise policies.
• Responsible for market-specific contract and NCQA accreditation compliance related to Population Health Clinical Operations.
• Supervises market-specific Population Health Clinical Operations staff.
Education / Experience:
• Bachelor's degree required in Nursing or healthcare-related field required
• Master's preferred or equivalent work-related experience.
• Clinical license is required, RN is preferred. LCSW or BH equivalent advanced licensure can be considered.
• CCM certification preferred within 2 years of hire.
• Three to five years of progressive management experience (including staff management) in a managed care environment.
• Experience with Managed Medicaid clinical programs is highly desirable.
• Experience with Foster Care is highly desirable.
• Knowledge of LTSS programs is highly desirable.
• Management experience with Case Management programs preferred.
• Experience in CM design and implementation is preferred. This should include experience in setting, communicating, and implementing strategic direction.
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 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.
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.
Candidates must reside in the State of South Carolina and be within a commutable distance of Charleston, SC and the SC State House in Columbia, SC
The Market Clinical Director of Population Health is responsible for market-specific clinical operations, supervising prenatal UM and ICM staff, and ensuring all market activities conform to enterprise program descriptions, policies, and procedures.
• Oversight of execution of market-specific clinical programs including prenatal UM, CM, and Bright Start.
• Assures compliance of program execution with enterprise policies
• Monitors performance metrics across multiple LOBs and assures that appropriate action is taken to address performance opportunities consistent with enterprise policies.
• Responsible for market-specific contract and NCQA accreditation compliance related to Population Health Clinical Operations.
• Supervises market-specific Population Health Clinical Operations staff.
Education / Experience:
• Bachelor's degree required in Nursing or healthcare-related field required
• Master's preferred or equivalent work-related experience.
• Clinical license is required, RN is preferred. LCSW or BH equivalent advanced licensure can be considered.
• CCM certification preferred within 2 years of hire.
• Three to five years of progressive management experience (including staff management) in a managed care environment.
• Experience with Managed Medicaid clinical programs is highly desirable.
• Experience with Foster Care is highly desirable.
• Knowledge of LTSS programs is highly desirable.
• Management experience with Case Management programs preferred.
• Experience in CM design and implementation is preferred. This should include experience in setting, communicating, and implementing strategic direction.
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 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.
💡 Quick Summary
Seeking a career-building opportunity? The Director Market Clinical Population Health | South Carolina position is now open for candidates interested in the Work from home Jobs sector. This role in North Charleston offers a professional environment and growth potential.
Requirement Snapshot: Candidates should possess basic communication skills, a proactive attitude, and the ability to work in a team. Experience in Work from home Jobs is a plus.
