AmeriHealth Caritas
Supervisor Behavioral Health Utilization Management Review
AmeriHealth Caritas, Newtown Square, Pennsylvania, United States, 19073
Role Overview
Under the supervision of the Manager for Utilization Management, this position is responsible for providing daily oversight of Utilization Management Reviewers, Utilization Management Review 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 customers. ;
Work Arrangement:
Monday through Friday, 8:00a EST to 5:00p EST or 8:00a EST to 4:30p EST.;
Available on weekends to provide support to staff.
;
Responsibilities:
;Assists with the daily operations of licensed and non-licensed professionals on the Utilization Management Review 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 Utilization Review.
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 AmeriHealth Caritas policies and procedures and Medicaid requirements.;
Education and Experience:
Registered Nurse candidates must have an Associate Degree in Nursing. Bachelor Degree in Nursing preferred.
Licensed Social Work candidates must have a Master Degree in Social Work.;
Must have a minimum of 3 years of clinical practice experience in behavioral health and/or substance use disorder. ;
Minimum of 3 years of Utilization Management Review experience in prior authorization or concurrent review ;within an insurance company and/or managed care organization.
Experience leading a remote team within a regulatory and compliance environment.
Supervisory experience leading a remote team in health plan operations, specifically Utilization Management.
Proficiency with Microsoft Office Suite (Outlook, Word, Excel, Teams, and PowerPoint) and electronic medical record and documentation programs.;
;
Licensure:
RN candidates must have an active and unencumbered license. Compact state license is desired.
LSW candidates must have an active and unencumbered license.
Additional licensure in DC, NH, OH, NC, and LA will be required to be obtained within 12 months from date of hire.;
;
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.
Under the supervision of the Manager for Utilization Management, this position is responsible for providing daily oversight of Utilization Management Reviewers, Utilization Management Review 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 customers. ;
Work Arrangement:
Monday through Friday, 8:00a EST to 5:00p EST or 8:00a EST to 4:30p EST.;
Available on weekends to provide support to staff.
;
Responsibilities:
;Assists with the daily operations of licensed and non-licensed professionals on the Utilization Management Review 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 Utilization Review.
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 AmeriHealth Caritas policies and procedures and Medicaid requirements.;
Education and Experience:
Registered Nurse candidates must have an Associate Degree in Nursing. Bachelor Degree in Nursing preferred.
Licensed Social Work candidates must have a Master Degree in Social Work.;
Must have a minimum of 3 years of clinical practice experience in behavioral health and/or substance use disorder. ;
Minimum of 3 years of Utilization Management Review experience in prior authorization or concurrent review ;within an insurance company and/or managed care organization.
Experience leading a remote team within a regulatory and compliance environment.
Supervisory experience leading a remote team in health plan operations, specifically Utilization Management.
Proficiency with Microsoft Office Suite (Outlook, Word, Excel, Teams, and PowerPoint) and electronic medical record and documentation programs.;
;
Licensure:
RN candidates must have an active and unencumbered license. Compact state license is desired.
LSW candidates must have an active and unencumbered license.
Additional licensure in DC, NH, OH, NC, and LA will be required to be obtained within 12 months from date of hire.;
;
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.