• Job Description

  Req#: 29621

  Your career starts now. We are 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 nations 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 would like to hear 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.

  Under the supervision of the LTSS Manager for Utilization Management, this position is responsible for providing daily oversight of LTSS Review UM Nurses, LTSS Review UM Technicians and staff members within the LTSS Review Utilization Management Department. Responsibilities include providing clinical, technical and operational support and direction, including organization and monitoring of all LTSS services. Responsible for direct supervisory oversight of professional and front line staff receiving requests for authorizations from Service Coordinators which encompasses participants.

  • Oversees the day to day operations of the LTSS Review UM Department, including authorization and approval of services and the coordination of benefits for all LTSS Participants.
  • Serves as a subject matter expert for LTSS training for internal care teams and external audiences.
  • Assists with the daily operations of licensed and non-licensed professionals in the LTSS Review UM Department.
  • 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 the LTSS Review UM Department.
  • Works collaboratively and supports the Service Coordination department of LTSS with other clinical and social services across the continuum of care striving to enhance the quality of Participant care and services.
  • 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 LTSS Utilization Review.
  • Accurately answers questions regarding CHC benefits for members and providers.
  • Maintains awareness and complies with Plan CHC authorization timeliness standards based on DHS/NCQA requirements.
  • 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 participants at all times.
  • Maintains operational processes, policies, procedures and reports to support LTSS care delivery.
  • Stays current with ACFC policies and procedures, Medicaid and CHC requirements.

  Education/ Experience:

  • Bachelor’s Degree required.
  • Unrestricted, current RN license.
  • 3 to 5 years progressive experience in an acute care setting or equivalent experience. Supervisory experience preferred.

  Diversity, Equity, and Inclusion

  At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

  We keep our associates happy so they can focus on keeping our members healthy.

  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.

• About the company

  AmeriHealth Caritas is a different kind of health care company. Our goal is to provide responsible managed care solutions, including Medicaid, Medicare, and CHIP — plus pharmacy benefit management, behavioral health, and administrative services.

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