Supervisor Utilization Management Review

AmeriHealth Caritas Logo
AmeriHealth Caritas
United States, United States (Remote)
  • Charity
  • FlexTime
  • Seasonal
  • Weekends
  • Applications have closed

Role Overview

The Utilization Management Review Supervisor manages a remote team of clinical reviewers. In this role, you will provide clinical, technical, and operational guidance to staff, oversee workflow and inventory, and ensure the team meets its goals through performance monitoring, auditing, coaching, and training.

Work Arrangement

  • Remote role.

  • Monday through Friday, 8:00a EST to 5:00p EST

  • Must be able to rotate weekend and evening hours based on business needs

  • Must be able to work 4 recognized company holidays to include Thanksgiving and Christmas (rotating)

Responsibilities

  • Team supervision: Provide daily oversight, support, and direction to a remote team of Utilization Management Reviewers

  • Clinical and technical support: Offer guidance on clinical and technical aspects of the review process

  • Operational oversight: Manage daily operations, including monitoring work assignments and adjusting based on staffing and request volume

  • Performance management: Ensure the team meets operational goals through auditing, coaching, and training

  • Inventory and workflow management: Oversee the inventory of prior authorization requests and manage workflow to ensure timely processing

  • Goal achievement: Monitor team productivity and other performance indicators to help the team achieve its operational goals

Education and Experience

  • Associate’s Degree in Nursing required; Bachelor’s Degree in Nursing preferred

  • Minimum of 5 years of clinical practice experience in an acute care setting

  • Minimum of 3 years of experience performing prior authorization reviews and/or concurrent reviews in a managed care environment required

  • Experience leading a remote Utilization Management team in a health plan

Licensure

  • Current and unencumbered OH RN license or Nurse Licensure Compact (NLC) required

Skills and Abilities

  • Strong analytical and problem-solving skills to review cases and identify trends

  • A high level of attention to detail to ensure accuracy in reviews

  • Excellent communication is required for interacting with staff, healthcare providers, and potentially members

  • Demonstrated proficiency in Microsoft Office applications to include Outlook, Word, Excel, Teams, PowerPoint

  • Familiarity with Electronic Medical Record (EMR) and healthcare documentation software

  • Proficiency with InterQual and proven track record of applying the criteria to complex Medicaid cases

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 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. We want to connect with you if you want to make a difference. Headquartered in Newtown Square, 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. 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.

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.

As a company, we support internal diversity through:

Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.

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