Long Term Services & Support Utilization Management Correspondence RN

Your career starts now. We’re looking for the next generation of health care 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 millions of lives through our national footprint of products, services, and award-winning programs.

Headquarters 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. Our services include integrated managed care products, pharmacy benefit management, specialty pharmacy services, behavioral health services, and other administrative solutions.

Discover more about us at www.amerihealthcaritas.com.

Responsibilities:

• Apply regulatory and accreditation standards, health benefit policies, and medical management guidelines to ensure letters provide appropriate justification for authorizing services and accurately deny services when guidelines are not met
• Maintain current knowledge of laws, regulations, Department of Human Services and accreditation requirements, and organizational policies, using professional judgment in their application
• Report noncompliance or emerging trends to leadership as appropriate

Work Arrangement: Remote position. Candidates in Eastern and Central Time Zones preferred.

Education and Experience:

• Bachelor’s degree required
• Three or more years of experience in a related clinical or social services setting required
• Experience in quality assurance preferred
• Experience in managed care or utilization review preferred
• Licensure: Active Registered Nurse license required

Skills and Abilities

• Strong written and verbal communication skills
• Ability to make sound decisions, identify problems, and recommend solutions
• Self-directed and able to work independently

Our Comprehensive Benefits Package

We offer flexible work solutions, including remote options and hybrid schedules, competitive pay, paid time off (including holidays and volunteer events), health insurance coverage for you and your dependents starting Day 1, 401(k), tuition reimbursement, and more.