Critical Incident Specialist

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.

The Critical Incident Specialist provides expertise and analysis to the Service Coordination Department to reduce the risk of noncompliance related to critical incidents. This role ensures timely reporting and documentation of incidents in internal and state systems, collaborates with cross-functional teams, and supports compliance with state and contractual requirements.

Responsibilities

• Coordinate and monitor critical incident reporting objectives to ensure compliance with Pennsylvania Community HealthChoices program requirements.
• Manage timely initiation, reporting, review, transcription, and completion of critical incidents in internal documentation systems and the Pennsylvania Enterprise Incident
• Management System.
• Collaborate with Service Coordination and Quality Management teams to maintain compliance and improve processes.
• Conduct ongoing reviews of critical incident activities and state requirements.

• Maintain current knowledge of contractual guidelines, plan policies, and operational procedures to effectively provide subject matter expertise as part of developing recommendations related to Critical Incident specific job aids, tip sheets, system improvements, and additional targeted interventions to achieve and maintain compliant scores related to Critical Incident Operational Reporting.

Education & Experience

• Bachelor’s Degree preferred.
• Minimum 1-3 years of experience in service coordination and/or quality review auditing.

Skills & Qualifications

• Strong technical and computer skills.
• Proficient in Microsoft Office Suite; intermediate skills in Excel and Word required.
• Demonstrated critical thinking and logical reasoning abilities.
• Experience with healthcare compliance systems and incident reporting processes preferred.

Additional Information

• Role is not member-facing; works closely with service coordinators and quality management.
• Familiarity with long-term services and supports (LTSS) is a plus.

• Must meet state-mandated reporting timelines (30 days).

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.