Responsible for preparing case management files and maintaining documentation for members eligible for Supplemental Security Income (SSI) benefits. Coordinates the application and renewal process by collaborating with members, providers, and government agencies.
Responsible for the preparation of case management files for assigned Plan members who are eligible to receive Supplemental Security Income (SSI) benefits and the creation and maintenance of case management documentation in the SSI database. Coordinates with the Manager of the DAP and the Utilization Management (UM) associates to receive monthly data loads and distribute member data to UM for the renewal process. Coordinates and facilitates the SSI application and renewal process by working closely with members, providers, Utilization Management (UM), and the local Medicaid office, as needed. Coordinates with UM to contact members and/or process mailings to Plan members identified as eligible for SSI renewal. Maintains relationships and works with providers to facilitate the exchange of medical documentation required to support SSI eligibility and continued benefits. Work involves frequent contact with members, medical service providers, government agencies, and others to obtain and verify medical and financial information needed to determine SSI eligibility.
Education/
Experience: High School Diploma/GED required. Associate’s degree preferred. 3 to 5 years managed care experience.
Preferred
Skills: Experience working with individuals with disabilities and diverse member populations in a case management, social services, or healthcare setting. Knowledge of medical terminology, medical record documentation, and healthcare information management practices. Proficiency with healthcare systems and applications, including Facets, Jiva, EXP, RightFax, and Microsoft Office Suite. Understanding of case management referral processes and applicable state regulations and requirements. Ability to identify, engage, and leverage cultural, social, and community-based resources to support member needs and promote positive outcomes. Strong communication, organization, and relationship-building skills, with the ability to collaborate effectively with members, providers, community partners, and internal teams. Our Comprehensive Benefits Package Flexible work solutions include remote options, hybrid work schedules, competitive pay, paid time off, holidays and volunteer events, health insurance coverage for you and your dependents starting Day 1, 401(k) retirement savings plan, tuition reimbursement, and more.
Why
Join Us: Your career starts now. We are looking for the next generation of healthcare 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 healthcare 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 are driven to make a difference, we want to hear from you. About AmeriHealth Caritas Headquartered in Newtown Square, Pennsylvania, AmeriHealth Caritas is a mission-driven organization with over 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. Our services include integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at http://www.amerihealthcaritas.com
Requires a High School Diploma or GED, with an Associate's degree preferred and 3 to 5 years of managed care experience. Candidates should have knowledge of medical terminology and proficiency in healthcare systems like Facets and Jiva.
Behavioral Health Caseworker
Behavioral Health Caseworker
Behavioral Health Caseworker
