Clinical Systems Administrator

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, 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:

As part of the clinical systems admin team, the Clinical Systems Administrator works with Clinical Services system vendors and IS to ensure medical management applications function appropriately and that all upgrades, enhancements and implementations are successful.

• Sets up, maintains and protects the integrity of the system administration module, config tables and config catalogs for the medical management application.
• Coordinates system changes, including tables, options, programing of sentinel rules, and guidelines and oversees system testing to make sure systems are working as expected.
• Works with various IS and vendor project managers to coordinate creation and successful migration of enhancements and system upgrades.
• Supports, maintains and updates correspondence in Client Letter and JIVA for existing and new business.
• Provides assistance to medical management training efforts, including training development and training delivery, as needed.
• Coordinates system auditing to confirm performance levels and identify potential areas for further investigation.
• Evaluates system reports, identifies/coordinates investigation and intervenes to resolve issues.
• Sets up, maintains, updates, as needed, provider portal rules and trigger tools. Maintains the integrity of the rules engine. Assist with training and support of the provider portal users.
  
  

Education/Experience:

• Bachelor’s Degree preferred
• 1-3 years Utilization and Case Management experience, Business Experience (Insurance, Healthcare, Finance, Medical Systems)
• Registered Nurse preferred
• Demonstrated ability to identify trends and conduct root-cause analyses
• Ability to provide constructive feedback with a focus on improved quality
• Ability to communicate in a positive/professional manner both orally and written
• Ability to follow detailed instructions with a high degree of accuracy
• Ability to work independently; complete tasks in the allotted time frame
• Strong problem solving skills and decision making skills
• Teamwork & teambuilding, decision making, and organizational effectiveness
• Programing experience required
• Working knowledge of Facets, Rightfax and EXP
• Proficient PC skills in a Windows based environment (excel, word, access database)
• Sound Personal Management Skills
• Demonstrated knowledge of plan benefit information and managed care (preferred)
• System administration experience (preferred)
• Good interpersonal, personal skills (preferred)
• Strong oral and written communication (preferred)
• Understanding of Compliance and Confidentiality information
• Ability to manage system admin support functions
• Ability to manage system admin advanced functions (preferred)
• Project lead (preferred)
• Informed decision making processes, including the utilization of data (preferred)
• Ability to work with a limited number of vendors (preferred)
• Ability to work with a multiple vendors (preferred)
  
  

Diversity, Equity, and Inclusion

At Amerihealth Caritas, everyone can feel valued, supported, and comfortable to be 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.