Supervisor Utilization Management Review
Posted on: January 15, 2022
Job BriefPosition requires an RN. Team provides rotating
coverage of holidays. At least 4 holidays a year will be
required.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
Philadelphia, 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:Under the supervision
of the Manager for Utilization Management, this position is
responsible for providing daily oversight of UM Nurses, UM
Technicians and staff members within Utilization Management.
Responsibilities include providing clinical, technical and
operational support and direction, including organization and
monitoring of all medical services. Responsible for direct
supervisory oversight of professional and front line staff
receiving requests for authorizations from external customers which
encompasses providers and members, as well as from the internal
- Assists with the daily operations of licensed and non-licensed
professionals on the Utilization Management team.
- Monitors staff work assignments and makes appropriate
adjustments based on staffing levels, staff experience, and
number/request types of authorizations/appeals received.
- Provides coaching and counseling to improve productivity of
staff members within Utilization Management.
- Assesses candidates and ensures that optimal qualifications are
met as a member of the department's interview team.
- Plans, develops and supports or conducts orientations, training
programs and creates educational material for staff members to
improve skills, aid in professional growth and development and to
ensure staff's expertise.
- Reviews quality audits and shares audit results in a timely
manner with associates, providing necessary education and
counseling to improve performance.
- Works collaboratively with the Manager and identified
leadership to develop and implement performance measures, and
monitors associates placed on performance improvement plans.
- Responsible for writing and finalizing annual reviews for
direct reports with Manager input.
- Participates in process reviews and the development of new
and/or revised work processes, policies and procedures relating to
- Accurately answers questions regarding Plan benefits for
members and providers.
- Acts as a liaison with outsides entities, including, but not
limited to, physicians, hospitals, health care vendors, social
service agencies, member advocates, regulatory agencies.
- Creates and supports an environment that fosters teamwork,
cooperation, respect, and diversity.
- Establishes and maintains positive communication and
professional demeanor with internal and external customers,
providers and members at all times.
- Stays current with ACFC policies and procedures and Medicare
- Associate's Degree.
- Bachelor's Degree Nursing.
- Registered Nurse.
- Unrestricted, current RN license.
- UM experience/certification.
- 3-5 years progressive experience in an acute care setting.
Minimum 3 years of experience in managed care utilization
- Proficiency with Microsoft Office Suite (Word, Excel, Power
- Access is a plus.
- Consistent word processing speed and accuracy of 50 or more
words per minute.
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Keywords: Amerihealth, Charleston , Supervisor Utilization Management Review, Executive , Charleston, South Carolina
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